Chronic subdural hematoma prognosis [Neurosurgery Wiki]

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====== Chronic subdural hematoma prognosis ======

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[[Chronic subdural hematoma]] (CSDH) is one of the most common clinical entities in daily neurosurgical practice which carries a most favorable [[prognosis]]. 


====== Chronic subdural hematoma recurrence ======

[[Chronic subdural hematoma recurrence]].

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The National Audit of Chronic Subdural Haematoma is collecting data prospectively in order to answer “ how are patients managed in the UK and what are their outcomes? ”. A collaborative process, which was overseen by the Academic Committee of the Society of British Neurological Surgeons (SBNS), led to the development of the first set of national audit standards for chronic subdural hematoma (CSDH) on the basis of best available evidence ((Coulter IC , Kolias AG , Marcus HJ , e t al . Proposal for a prospective
multi- centre audit of chronic subdural haematoma management
in the United Kingdom and Ireland . Br J Neurosurg 2013 [Epub
ahead of print ; doi:10.3109/02688697.2013.835378])).

The Audit has already collected data on over 700 patients and has therefore become the largest multicentre
prospective study of CSDH worldwide, has helped to firmly establish the feasibility of collaborative research networks in the field of neurosurgery. 

Establishment of collaborative networks together with the developing neurosurgical research infrastructure will ensure a bright future for clinical research in neurosurgery ((Bhangu A , Kolias A G, Pinkney T , Hall N J, Fitzgerald J E. Surgical research collaboratives in the UK . Lancet 2013 ; 382 : 1091 – 2 .)).

A high mortality index in the postoperative period was found in patients with INR (international normalized ratio) values greater than 1.25 and/or thrombocytopenia (p<0.001 and p=0.004 respectively)
((Yasuda CL, Morita ME, Nishimori FY, Yasuda AM, Alves HL. [Chronic subdural
hematoma: study of 161 patients and the relationship with coagulation
abnormalities]. Arq Neuropsiquiatr. 2003 Dec;61(4):1011-4. Epub 2004 Jan 6.
Portuguese. PubMed PMID: 14762608.)).

Surgical drainage of chronic SDHs in nonagenarians and centenarians is associated with lower incidence of inpatient death and higher 30-day and 6-month survival rates
((Lee L, Ker J, Ng HY, Munusamy T, King NK, Kumar D, Ng WH. Outcomes of chronic 
subdural hematoma drainage in nonagenarians and centenarians: a multicenter
study. J Neurosurg. 2015 Jul 10:1-6. [Epub ahead of print] PubMed PMID: 26162032.)).

====== Aesthetic outcome ======

The aesthetic outcome after [[burr hole]] [[trepanation]] for the evacuation of chronic subdural hematomas (cSDH) is often unsatisfactory, as the bony skull defects may cause visible skin depressions. 

===== Retrospective cohort studies =====

Sayed et al. conducted a large [[retrospective cohort study]] of patients who underwent a cSDH evacuation at a single urban institution between 2015 and 2022. Data were collected from the electronic medical record on prior comorbidities, anticoagulation use, mental status on presentation, preoperative labs, and preoperative/postoperative imaging parameters. Univariate and multivariate analyses were conducted to analyze predictors of [[mortality]]. Mortality during admission for this cohort was 6.1%. Univariate analysis showed the mortality rate was higher in those presenting with a history of [[dialysis]]. In addition, those who presented with altered [[mental status]] were intubated, and lower GCS scores had higher rates of [[postoperative mortality]]. Usage of [[Coumadin]] was correlated with higher rates of POM. Examination of preoperative labs showed that patients who presented with anemia or thrombocytopenia had higher POM. Imaging data showed that cSDH volume and greatest dimension were correlated with higher rates of POM. Finally, patients who were not extubated postoperatively had higher rates of POM. Multivariate analysis showed that only altered mental status and not being extubated postoperatively were correlated with a higher risk of mortality. In summation, they demonstrated that altered mental status and failure to extubate were independent predictors of mortality in cSDH evacuation. Interestingly, patient age was not a significant predictor of mortality
((Sayed R, Gross S, Zamarud A, Nie L, Mudhar G, Eikermann M, Rupp S, Kim J, Babar M, Basam M, Yassari R, Gelfand Y. Predictors of mortality in chronic subdural hematoma evacuation. Neurosurg Rev. 2023 Dec 1;46(1):318. doi: 10.1007/s10143-023-02213-y. PMID: 38036800.)).