Abstract
BackgroundChronic subdural haematoma (cSDH) is a common neurosurgical pathology frequently occurring in older patients. The impact of population ageing on cSDH caseload has not been examined, despite relevance for health system planning.MethodsThis is a single-centre study from the UK. Operated cases of cSDH (n = 446) for 2015–2018 were identified. Crude and directly standardised incidence rates were calculated. Medline and EMBASE were systematically searched to identify studies reporting on the incidence of cSDH by year, so an estimate of rate of incidence change could be determined. Local incidence rates were then applied to population projections for local catchment area to estimate operated cSDH numbers at 5 yearly intervals due to shifting demographics.ResultsWe identified nine studies presenting incidence estimates. Crude estimates for operative cases ranged from 1.3/100,000/year (1.4–2.2) to 5.3/100,000/year (4.3–6.6). When non-operated cases were included, incidence was higher: 8.2/100,000/year (6.0–11.2) to 48/100,000/year (37.7–61.1). Four pairs of studies demonstrated incidence rate increases of 200–600% over the last 50 years, but data was deemed too heterogeneous to generate formal estimate of incidence change. Local crude incidence of operated cSDH was 3.50/100,000/year (3.19–3.85). Directly standardised incidence was 1.58/100,000/year (1.26–1.90). After applying local incidence rates to population projections, case numbers were predicted to increase by 53% over the next 20 years.ConclusionsThe incidence of cSDH is increasing. We project a 53% increase in operative caseload within our region by 2040. These are important findings for guiding future healthcare planning.
Highlights
Chronic subdural haematoma is a common neurosurgical condition, consisting of a collection of altered blood lying beneath the dural membrane
Significant numbers occur after no significant antecedent trauma, perhaps due to an inflammatory process occurring at the level of the dural border cell [9]. Chronic subdural haematoma (cSDH) is widely considered a disease of old age [28] with significant levels of comorbidity and polypharmacy present amongst those referred for surgery [7]
We present our local incidence rate of operated cSDH and, using population projections from the office for national statistics (ONS), estimate the projected change in operative workload that could arise due to demographic shifts
Summary
Chronic subdural haematoma (cSDH) is a common neurosurgical condition, consisting of a collection of altered blood lying beneath the dural membrane. The demography of the worldwide and UK population is changing due to a combination of falling fertility and mortality rates, and by 2039, it is estimated that the number of individuals aged over 60 will increase from 14.9 to 21.9 million [12]. Such a change in population structure will lead to rising numbers of conditions associated with older age [12]. Local incidence rates were applied to population projections for local catchment area to estimate operated cSDH numbers at 5 yearly intervals due to shifting demographics. After applying local incidence rates to population projections, case numbers were predicted to increase by 53% over the 20 years.
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