Morbidity and Mortality After Burr Hole Craniostomy Versus Craniotomy for Chronic Subdural Hematoma Evacuation: A Single-Center Experience

Raghavan, Alankrita; Smith, Gabriel A.; Onyewadume, Louisa; Peck, Matthew R.; Herring, Eric; Pace, Jonathan; Rogers, Matt; Momotaz, Hasina; Hoffer, S. Alan; Hu, Yin; Liu, Hongyan; Tatsuoka, Curtis; Sajatovic, Martha; Sloan, Andrew E.

doi:10.1016/j.wneu.2019.10.023

Cited by 17 publications

(12 citation statements)

References 29 publications

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“…While the mFI-11 is the most commonly used frailty measure in the literature, to date, no study has examined the mFI-11 or mFI-5 among patients with cSDH; an effect that may reflect a publication bias. Furthermore, while there have been previous studies investigating the relationship between the CCI and cSDH prognosis, there are conflicting results with some finding that the CCI is independently associated with cSDH recurrence [ 23 ], increased complications [ 24 , 25 ] and long-term mortality [ 26 ], while others have shown no such effects [ 2 , 27 ]. Differences in these studies may be attributed to inclusion criteria, with some groups, including our own, examining all cSDH patients, while others only examined certain types of operative patients.…”

Section: Discussionmentioning

confidence: 99%

“…Chronic subdural hemorrhage (cSDH) is an increasingly common pathology encountered in modern neurosurgical practice given its high frequency among the elderly [ 1 ]. The outcomes following cSDH are generally positive, but one large, recent cohort study found that age is correlated with poorer functional outcomes and lower rates of discharge home, and the majority of patients with cSDH are in their 80s [ 2 ]. While both advanced chronological age and low initial Glasgow Coma Score (iGCS) are established predictors of poorer outcomes following cSDH, [ 2 ] there is a paucity of information regarding the effect of a patients’ underlying comorbidities on cSDH prognosis.…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Frailty versus Initial Glasgow Coma Score in Predicting Outcomes Following Chronic Subdural Hemorrhage: A Preliminary Analysis

McIntyre

Rawanduzy

Afridi

et al. 2020

Cureus

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Background Initial Glasgow Coma Score (iGCS) is a well-known predictor of adverse outcomes following chronic subdural hemorrhage (cSDH). Frailty, i.e. a reduced physiologic reserve, is associated with poorer outcomes across the surgical literature, however, there is no consensus on the best measure of frailty. To date, no study has compared frailty’s ability to predict cSDH outcomes versus iGCS. The goal of this study was to, therefore, examine the prognostic value of the 5- (mFI-5) and 11-factor (mFI-11) modified frailty index, and Charlson Comorbidity Index (CCI) versus iGCS following cSDH. Methods Between January, 2016 and June, 2018, patients who presented to the emergency department with cSDH were retrospectively identified using the International Classification of Diseases (ICD) codes. mFI-5, mFI-11, and CCI scores were calculated using patient baseline characteristics. Primary endpoints were death and discharge home and subgroup analyses were performed among operative cSDH. Univariate and multivariate logistic regressions were used to determine predictors of primary endpoints. Results Of the 109 patients identified, the average age was 72.6±1.6 years and the majority (69/109, 63.3%) were male. The average CCI, mFI-5, and mFI-11 were 4.5 ±0.2, 1.5 ±0.1, and 2.2 ±0.1, respectively. Fifty (45.9%) patients required surgical intervention, 11 (10.1%) died, and 48 (43.4%) were discharged home. In the overall cohort, while the only multivariate predictor of mortality was iGCS (OR=0.58; 95%CI:0.44-0.77; p=0.0001), the CCI (OR=0.73; 95%CI:0.58-0.92; p=0.0082) was a superior predictor of discharge home compared to iGCS (OR=1.46; 95%CI:1.13-1.90; p=0.0041). Conversely, among those who received an operative intervention, the CCI, but not iGCS, independently predicted both mortality (OR=4.24; 95%CI:1.01-17.86; p=0.0491) and discharge home (OR=0.55; 95%CI:0.33-0.90; p=0.0170). Neither mFI nor age predicted primary outcomes in multivariate analysis. Conclusion While frailty is associated with worse surgical outcomes, the clinical utility of the mFI-5, mFI-11, and CCI in cSDH is unclear. We show that the iGCS is an overall superior predictor of mortality following cSDH but is outperformed by the CCI after operative intervention. Similarly, the CCI is the superior predictor of discharge home in cSDH patients overall and following an operative intervention. These results indicate that while the iGCS best predicts mortality overall, the CCI may be considered when prognosticating post-operative course and hospital disposition.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Effect of Frailty versus Initial Glasgow Coma Score in Predicting Outcomes Following Chronic Subdural Hemorrhage: A Preliminary Analysis

McIntyre

Rawanduzy

Afridi

et al. 2020

Cureus

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“…Some surgeons have attributed a higher recurrence to the type of procedure used. In the series by Raghavan et al, a burr hole had a greater recurrence rate (15.5%) than a craniotomy (7.5%) [18]. However, Shim et al found a higher incidence with craniotomy (47%) than burr hole (13%) [9].…”

Section: Discussionmentioning

confidence: 94%

Burr Hole Surgery for Drainage of Chronic and Subacute Subdural Hematomas: Low Recurrence Rate in a Single Surgeon Cohort

Jesús¹,

Monserrate²

2021

Cureus

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“…Several studies have questioned the role of surgical intervention in attenuating mortality following moderate to severe TBI, particularly in older patients. [16][17][18] Reported mortality following emergent neurosurgical interventions ranges between 10 and 31%, specifically 10-25% for TBI, 30% for intraparenchymal hemorrhages, and 31% for ruptured aneurysms. [19][20][21] Furthermore, there is an association between neurological diseases and withdrawal of care in the ICU due to projected poor neurological and functional outcomes.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Organ System Surgery on Intensive Care Unit Mortality in a Cohort of Critically Ill Surgical Patients

Shchatsko

Purcell

Tignanelli

et al. 2020

The American Surgeon™

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Background The critical illness burden in the United States is growing with an aging population obtaining surgical intervention despite age-related comorbidities. The effect of organ system surgical intervention on intensive care units (ICUs) mortality is unknown. Methods We performed an 8-year retrospective analysis of surgical ICU patients. Poisson regression analysis was performed assessing the relative risk of in-hospital mortality based on surgical intervention. Results Of 468 000 ICU patients included, 97 968 (20.9%) were surgical admissions and 97 859 (99.9%) had complete outcomes data. Nonsurvivors were older (68.8 ± 15.4 vs. 62.7 ± 15.8 years, P < .001) with higher Acute Physiology, Age, Chronic Health Evaluation (APACHE) III Scores (81.4 ± 33.6 vs. 46.7 ± 20.1, P < .001. Patients with gastrointestinal (GI) (n = 1,558, 7.8%), musculoskeletal (n = 277, 5.5%), and neurological (n = 884, 4.6%) system operations had the highest mortality. Upon Poisson regression model, patients undergoing emergent operative interventions on the neurologic system (RR 1.86, 95% CI 1.67-2.07, P < .001) had increased relative risk of mortality when compared to emergent operative interventions on the cardiovascular system after controlling for pertinent covariates. Elective operative interventions on the respiratory (RR 2.39, 95% CI 2.03-2.80, P < .001), GI (RR 2.34, 95% CI 2.10-2.61, P < .001), and skin and soft tissue (RR 2.26, 95% CI 1.77-2.89, P < .001) systems had increased risk of mortality when compared to elective cardiovascular system surgery after controlling for pertinent covariates. Conclusion We found significant differences in the risk of mortality based on organ system of operative intervention. The prognostication of critically ill patients undergoing surgical intervention is currently not accounted for in prognostic scoring systems.

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Morbidity and Mortality After Burr Hole Craniostomy Versus Craniotomy for Chronic Subdural Hematoma Evacuation: A Single-Center Experience

Cited by 17 publications

References 29 publications

The Effect of Frailty versus Initial Glasgow Coma Score in Predicting Outcomes Following Chronic Subdural Hemorrhage: A Preliminary Analysis

The Effect of Frailty versus Initial Glasgow Coma Score in Predicting Outcomes Following Chronic Subdural Hemorrhage: A Preliminary Analysis

Burr Hole Surgery for Drainage of Chronic and Subacute Subdural Hematomas: Low Recurrence Rate in a Single Surgeon Cohort

The Effect of Organ System Surgery on Intensive Care Unit Mortality in a Cohort of Critically Ill Surgical Patients

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