Abstract
BackgroundThe decision whether to operate or not in patients with a traumatic acute subdural hematoma (t-ASDH) can, in many cases, be a neurosurgical dilemma. There is a general conception that operating on severe cases leads to the survival of severely disabled patients and is associated with relatively high medical costs. There is however little information on the quality of life of patients after operation for t-ASDH, let alone on the cost-effectiveness.MethodsThis study retrospectively investigated patient outcome and in-hospital costs for 108 consecutive patients with a t-ASDH. Patient outcome was assessed using the Glasgow Outcome Score (GOS) and the Traumatic Brain Injury (TBI)–specific QOLIBRI questionnaire. The in-hospital costs were calculated using the Dutch guidelines for costs calculation.ResultsOut of 108 patients, 40 were classified as having sustained a mild (Glasgow Coma Scale (GCS) 13–15), 19 a moderate (GCS 9–12), and 49 a severe (GCS 3–8) TBI. As expected, mortality rates increased with higher TBI severity (23%, 47%, and 61% respectively), whereas the chance for favorable outcome (GOS 4–5) decreased (72%, 47%, and 29%). Interestingly, the mean QOLIBRI scores for survivors were quite similar between the TBI severity groups (61, 61, and 64). Healthcare consumption and in-hospital costs increased with TBI severity. In-hospital costs were relatively high (€24,980), especially after emergency surgery (€28,670) and when additional ICP monitoring was used (€36,580).ConclusionsAlthough this study confirms that outcome is often “unfavorable” after t-ASDH, it also shows that “favorable” outcome can be achieved, even in the most severely injured patients. In-hospital treatment costs were substantial and mainly related to TBI severity, with admission and surgery as main cost drivers. These results serve as a basis for necessary future research focusing on the value-based cost-effectiveness of surgical treatment of patients with a t-ASDH.
Highlights
Traumatic brain injury (TBI) is accompanied by an acute subdural hematoma (t-ASDH) in around 10–20% of admitted Traumatic Brain Injury (TBI) patients [4]
Because patient outcome and in-hospital costs of patients with a traumatic acute subdural hematoma (t-ASDH) are of great individual and societal importance, the aim of this study is threefold: (1) assess functional outcome and TBI-specific health-related quality of life (HRQoL), (2) calculate the in-hospital costs, and (3) serve as a basis for future research that focusses on the cost-effectiveness of surgical treatment of patients with t-ASDH
A concomitant intracranial hematoma that did not require surgical intervention was present in 44.4% of patients and 11.1% had clinically relevant extracranial injuries
Summary
Traumatic brain injury (TBI) is accompanied by an acute subdural hematoma (t-ASDH) in around 10–20% of admitted TBI patients [4]. Mortality rate is high (40–60%) and outcome is often unfavorable (up to 70%) [4, 9, 21, 31] This frequently poses an ethical dilemma for neurosurgeons, especially in the more severe cases. The decision whether to operate or not in patients with a traumatic acute subdural hematoma (t-ASDH) can, in many cases, be a neurosurgical dilemma. In-hospital treatment costs were substantial and mainly related to TBI severity, with admission and surgery as main cost drivers. These results serve as a basis for necessary future research focusing on the value-based cost-effectiveness of surgical treatment of patients with a t-ASDH
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