Predictive factors for recurrence and clinical outcomes in patients with chronic subdural hematoma

Abstract

OBJECTIVE Chronic subdural hematoma (CSDH) is a common type of intracranial hemorrhage in elderly patients. Many studies have suggested various factors that may be associated with the recurrence of CSDH. However, the results are inconsistent. The purpose of this study was to determine the associations among patient factors, recurrence, and clinical outcomes of CSDH after bur hole surgery performed during an 11-year period at twin hospitals. METHODS Kaplan-Meier analysis was performed to evaluate the risk factors for CSDH recurrence. Univariate and multivariate Cox proportional hazards regression analyses were used to calculate hazard ratios with 95% CIs for CSDH recurrence based on many variables. One-way repeated-measures ANOVA was used to assess the differences in the mean modified Rankin Scale score between categories for each risk factor during each admission and at the last follow-up. RESULTS This study was a retrospective analysis of 756 consecutive patients with CSDH who underwent bur hole surgery at the Hanyang University Medical Center (Seoul and Guri) between January 1, 2004, and December 31, 2014. During the 6-month follow-up, 104 patients (13.8%) with recurrence after surgery for CSDH were identified. Independent risk factors for recurrence were as follows: age > 75 years (HR 1.72, 95% CI 1.03-2.88; p = 0.039), obesity (body mass index ≥ 25.0 kg/m), and a bilateral operation. CONCLUSIONS This study determined the risk factors for recurrence of CSDH and their effects on outcomes. Further studies are needed to account for these observations and to determine their underlying mechanisms.

Predictors of acute intracranial hemorrhage and recurrence of chronic subdural hematoma following burr hole drainage

“…The recurrence rate in unilateral CSDH is lower than that of bilateral CSDH, making bilateral hematoma a risk factor for CSDH recurrence [16,19]. This could be due to poor brain re-expansion in bilateral CSDH compared to unilateral CSDH, which may result in a brain parenchymal shift, tearing of the blood vessels, postoperative pneumocephalus and cerebrospinal fluid accumulation in the hematoma cavity, leading to a higher recurrence rate [19,34,35]. Another theory is that patients with bilateral CSDH tend to have a history of brain atrophy, which leads to poor re-expansion, resulting in a higher recurrence rate [19,35].…”

“…This could be due to poor brain re-expansion in bilateral CSDH compared to unilateral CSDH, which may result in a brain parenchymal shift, tearing of the blood vessels, postoperative pneumocephalus and cerebrospinal fluid accumulation in the hematoma cavity, leading to a higher recurrence rate [19,34,35]. Another theory is that patients with bilateral CSDH tend to have a history of brain atrophy, which leads to poor re-expansion, resulting in a higher recurrence rate [19,35]. In our study, bilateral hematoma was found to be a risk factor for postoperative recurrence of CSDH, but was not a risk factor for postoperative AIH.…”

“…BHD is the most widely used technique, and has a satisfactory outcome, but has a CSDH recurrence rate of 4-38% [6][7][8][9][10][11][12]. Several studies have revealed that predictors of CSDH recurrence following surgical evacuation include age, sex, antiplatelet or anticoagulation therapy, Glasgow Coma Scale (GCS), diabetes mellitus, hypertension, bilateral hematoma, preoperative hematoma size, midline shift, hematoma density, intraoperative irrigation, type of surgery and postoperative air collection, however, these results are inconsistent [7,[13][14][15][16][17][18][19]. The more controversial risk factors include surgery type and intraoperative irrigation [9,10,[20][21][22].…”

Recurrent Chronic Subdural Hematoma: Clinical and Imaging Risk Factors

“…18 In this report, 12 (11.65%) patients showed a recurrence of their hematoma. There were 18 (12%) recurrences among the 149 CSDH cases in the study by Kale et al, 18 nine (10%) recurrences in 90 patients in the study by Han 9 who identified 104 (13.8%) patients with recurrence after surgery for CSDH in a group of 756 patients. However, there is a large amount of variability in the literature concerning this second surgery (see ►Table 6).…”

“…Although their findings are inconsistent, numerous studies have reported various potential RF. 4,[7][8][9][10][11][12][13][14][15] Three categories of factors have been recognized: patient comorbidities, imaging data, and surgical modalities. We performed this study to investigate the causal RF for CSDH and to determine whether there is a cumulative effect due to the association of diabetes mellitus (DM) with any other disease that would predict recurrence.…”