Abstract
Background: Growing evidence suggests that chronic subdural hematoma (CSDH) may have long-term adverse effects even after surgical evacuation. Hematoma recurrence is commonly reported as a short-term, postoperative outcome measure for CSDH, but other measures such as hematoma resolution may provide better insight regarding mechanisms behind longer-term sequelae. This study aims to characterize postoperative resolution times and identify predictors for this relatively unexplored metric.Methods: Consecutive cases (N = 122) of burr hole evacuation for CSDH by a single neurosurgeon at Columbia University Irving Medical Center from 2000 to 2019 were retrospectively identified. Patient characteristics, presenting factors, and date of hematoma resolution were abstracted from the electronic health record. Outcome measures included CSDH resolution at 6 months, surgery-to-resolution time, and inpatient mortality. Univariate and multivariate analyses were performed to determine predictors of outcome measures.Results: Hematoma resolution at 6 months was observed in 58 patients (47.5%), and median surgery-to-resolution time was 161 days (IQR: 85–367). Heavy drinking was predictive of non-resolution at 6 months and longer surgery-to-resolution time, while increased age was predictive of non-resolution at 6 months. Antiplatelet agent resumption was associated with non-resolution at 6 months and longer surgery-to-resolution time on univariate analysis but was not significant on multivariate analysis.Conclusion: Postoperative resolution times for most CSDHs are on the order of several months to a year, and delayed resolution is linked to heavy drinking and advanced age. Subsequent prospective studies are needed to directly assess the utility of hematoma resolution as a potential metric for long-term functional and cognitive outcomes of CSDH.
Highlights
Chronic subdural hematoma (CSDH) has become an increasingly common neurological condition worldwide, with an estimated incidence of up to 20.6 per 100,000 persons per year [1] and 58 per 100,000 per year for those 70 years of age and older [2, 3]
At the time of CSDH diagnosis, antiplatelet agents were used in 51 (41.8%) patients (86.3% of which were on aspirin) and anticoagulants were used in 20 (16.4%) patients (60.0% of which were on warfarin)
Of the patient demographic factors, medical comorbidities, and presenting characteristics we investigated, history of heavy drinking was found to be predictive of CSDH non-resolution at 6 months and longer surgery-to-resolution time, and advanced age was predictive of non-resolution at 6 months
Summary
Chronic subdural hematoma (CSDH) has become an increasingly common neurological condition worldwide, with an estimated incidence of up to 20.6 per 100,000 persons per year [1] and 58 per 100,000 per year for those 70 years of age and older [2, 3]. Several studies have used hematoma recurrence as a primary outcome variable and investigated predictors for this outcome [3, 7,8,9,10,11]. The results of these analyses are quite heterogeneous, due in part to discrepancies in defining CSDH recurrence and variation in surgical and follow-up protocol [12]. In our single-center retrospective study, we aimed to characterize and elucidate potential predictors of CSDH resolution and surgeryto-resolution time. Growing evidence suggests that chronic subdural hematoma (CSDH) may have long-term adverse effects even after surgical evacuation. This study aims to characterize postoperative resolution times and identify predictors for this relatively unexplored metric
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