Chronic subdural hematoma\u2014incidence, complications, and financial impact

Minna Rauhala,Juha Öhman,Tero Niskakangas,Teemu M Luoto,Grant L Iverson,Pauli Helén,Heini Huhtala,Paula Heikkilä

doi:10.1007/s00701-020-04398-3

Abstract

ObjectiveTo examine the population-based incidence, complications, and total, direct hospital costs of chronic subdural hematoma (CSDH) treatment in a neurosurgical clinic during a 26-year period. The aim was also to estimate the necessity of planned postoperative follow-up computed tomography (CT).MethodsA retrospective cohort (1990–2015) of adult patients living in Pirkanmaa, Finland, with a CSDH was identified using ICD codes and verified by medical records (n = 1148, median age = 76 years, men = 65%). Data collection was performed from medical records. To estimate the total, direct hospital costs, all costs from hospital admission until the last neurosurgical follow-up visit were calculated. All patients were followed until death or the end of 2017. The annual number of inhabitants in the Pirkanmaa Region was obtained from the Statistics Finland (Helsinki, Finland).ResultsThe incidence of CSDH among the population 80 years or older has increased among both operatively (from 36.6 to 91/100,000/year) and non-operatively (from 4.7 to 36.9/100,000/year) treated cases. Eighty-five percent (n = 978) underwent surgery. Routine 4–6 weeks’ postoperative follow-up CT increased the number of re-operations by 18% (n = 49). Most of the re-operations (92%) took place within 2 months from the primary operation. Patients undergoing re-operations suffered more often from seizures (10%, n = 28 vs 3.9%, n = 27; p < 0.001), empyema (4.3%, n = 12 vs 1.1%, n = 8; p = 0.002), and pneumonia (4.7%, n = 13 vs 1.4%, n = 12; p = 0.008) compared with patients with no recurrence. The treatment cost for recurrent CSDHs was 132% higher than the treatment cost of non-recurrent CSDHs, most likely because of longer hospital stay for re-admissions and more frequent outpatient follow-up with CT. The oldest group of patients, 80 years or older, was not more expensive than the others, nor did this group have more frequent complications, besides pneumonia.ConclusionsBased on our population-based study, the number of CSDH patients has increased markedly during the study period (1990–2015). Reducing recurrences is crucial for reducing both complications and costs. Greater age was not associated with greater hospital costs related to CSDH. A 2-month follow-up period after CSDH seems sufficient for most, and CT controls are advocated only for symptomatic patients.

Highlights

Chronic subdural hematoma (CSDH) is a common disease in neurosurgical practice among elderly patients and it is associated with substantial morbidity and mortality [5, 10, 25, 27, 41]
Surgical treatment is recommended in CSDH patients with neurological symptoms, and the preferred surgical technique is burr-hole drainage [26, 37]
In a German study of 208 patients with a recurrence rate of 18%, the majority (92%) of recurrences occurred within 60 days [34]

Summary

Introduction

Chronic subdural hematoma (CSDH) is a common disease in neurosurgical practice among elderly patients and it is associated with substantial morbidity and mortality [5, 10, 25, 27, 41]. The incidence of CSDH has increased during the last decades [1, 4, 14, 18]. We have previously published the epidemiological findings of our Finnish CSDH cohort (1990–2015), in which the overall incidence doubled from 8.2 to 17.6/100,000/year [33], and nearly tripled among the population 80 years or older. The global population of people aged 80 and older is expected to more than triple between 2015 and 2050 [16]. There is a growing healthcare burden related to CSDH. A few studies have described the financial impact of CSDH [12, 13, 35]

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