Skip to main content

Standardized assessment of outcome and complications in chronic subdural hematoma: results from a large case series

Abstract

Introduction

Chronic subdural hematomas (cSDH) are commonly deemed to have a benign prognosis. However, detailed and standardized data describing outcome and complications in a large prospective patient cohort is lacking.

Methods

Retrospective analysis of prospectively collected data in our institutional patient registry on consecutive patients undergoing surgery for cSDH from 2013 to 2017. Complications were assessed according to the Clavien-Dindo grading system (CDG). The outcome was measured with respect to two endpoints: occurrence of a complication with CDG 3–5 and lack of improvement in Karnofsky Performance Status (KPS) at the last follow-up.

Results

Out of 435 operations, 166 (38.3%) presented a complication until 3 months postoperative (CDG 1, 23 (5.3%); CDG 2, 62 (14.3%); CDG 3a, 7 (1.6%); CDG 3b, 64 (14.7%); CDG 4a, 2 (0.5%); and CDG 5, 8 (1.8%)). Higher CDG correlated with a lower KPS (rs = − 0.27, p < 0.001). A lack of improvement in KPS was associated with a Charlson Comorbidity Index (CCI) > 1 and the iso- or hypodense appearance of the cSDH.

Conclusions

This study provides a reliable estimate of the rate of medical and surgical complications in cSDH surgery. Complications that required a surgical intervention turned out to be rare. Recording complications in a standardized and prospective fashion can therefore serve as a basis for assessing patient outcome and quality control within the department.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

Abbreviations

ASA :

American Society of Anesthesiology Classification of Perioperative Risk

BMI :

Body mass index

CCI :

Charlson Comorbidity Index

CDG :

Clavien-Dindo grading system

cSDH :

Chronic subdural hematoma

GCS :

Glasgow Coma Scale

IQR :

Interquartile range

KPS :

Karnofsky Performance Status

mRS :

Modified Rankin Scale

NIHSS :

National Institute of Health Stroke Scale

SD :

Standard deviation

References

  1. Adhiyaman V, Asghar M, Ganeshram KN, Bhowmick BK (2002) Chronic subdural haematoma in the elderly. Postgrad Med J 78:71–75

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Bartek J, Sjåvik K, Kristiansson H, Ståhl F, Fornebo I, Förander P, Jakola AS (2017) Predictors of recurrence and complications after chronic subdural hematoma surgery: a population-based study. World Neurosurg 106:609–614

    Article  PubMed  Google Scholar 

  3. Bartek J, Sjåvik K, Schaible S, Gulati S, Solheim O, Förander P, Jakola AS (2018) The role of angiotensin-converting enzyme inhibitors in patients with chronic subdural hematoma: a Scandinavian population-based multicenter study. World Neurosurg 113:e555–e560

    Article  PubMed  Google Scholar 

  4. Bartek J, Sjåvik K, Ståhl F, Kristiansson H, Solheim O, Gulati S, Sagberg LM, Förander P, Jakola AS (2017) Surgery for chronic subdural hematoma in nonagenarians: a Scandinavian population-based multicenter study. Acta Neurol Scand 136:516–520

    Article  PubMed  Google Scholar 

  5. Borger V, Vatter H, Oszvald Á, Marquardt G, Seifert V, Güresir E (2012) Chronic subdural haematoma in elderly patients: a retrospective analysis of 322 patients between the ages of 65-94 years. Acta Neurochir 154:1549–1554

    Article  PubMed  Google Scholar 

  6. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196

    Article  PubMed  Google Scholar 

  7. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  8. Dumont TM, Rughani AI, Goeckes T, Tranmer BI (2013) Chronic subdural hematoma: a sentinel health event. World Neurosurg 80:889–892

    Article  PubMed  Google Scholar 

  9. Ernestus RI, Beldzinski P, Lanfermann H, Klug N (1997) Chronic subdural hematoma: surgical treatment and outcome in 104 patients. Surg Neurol 48:220–225

    Article  CAS  PubMed  Google Scholar 

  10. Farhat Neto J, Araujo JL, Ferraz VR, Haddad L, Veiga JC (2015) Chronic subdural hematoma: epidemiological and prognostic analysis of 176 cases. Rev Col Bras Cir 42:283–287

    Article  PubMed  Google Scholar 

  11. Fornebo I, Sjåvik K, Alibeck M, Kristiansson H, Ståhl F, Förander P, Jakola AS, Bartek J (2017) Role of antithrombotic therapy in the risk of hematoma recurrence and thromboembolism after chronic subdural hematoma evacuation: a population-based consecutive cohort study. Acta Neurochir 159:2045–2052

    Article  PubMed  Google Scholar 

  12. Ivamoto HS, Lemos HP, Atallah AN (2016) Surgical treatments for chronic subdural hematomas: a comprehensive systematic review. World Neurosurg 86:399–418

    Article  PubMed  Google Scholar 

  13. Lee L, Ker J, Ng HY, Munusamy T, King NK, Kumar D, Ng WH (2016) Outcomes of chronic subdural hematoma drainage in nonagenarians and centenarians: a multicenter study. J Neurosurg 124:546–551

    Article  PubMed  Google Scholar 

  14. Maldaner N, Sarnthein J, Bozinov O, Regli L, Neidert MC (2018) Neurosurgery in octogenarians: a prospective study of perioperative morbidity, mortality, and complications in elderly patients. World Neurosurg 110:e287–e295. https://doi.org/10.1016/j.wneu.2017.10.154

    Article  PubMed  Google Scholar 

  15. Maldaner N, Sosnova M, Sarnthein J, Bozinov O, Regli L, Stienen MN (2018) Burr hole trepanation for chronic subdural hematomas: is surgical education safe? Acta Neurochir 160:901–911

    Article  PubMed  Google Scholar 

  16. Miranda LB, Braxton E, Hobbs J, Quigley MR (2011) Chronic subdural hematoma in the elderly: not a benign disease. J Neurosurg 114:72–76

    Article  PubMed  Google Scholar 

  17. Mori K, Maeda M (2001) Surgical treatment of chronic subdural hematoma in 500 consecutive cases: clinical characteristics, surgical outcome, complications, and recurrence rate. Neurol Med Chir (Tokyo) 41:371–381

    Article  CAS  Google Scholar 

  18. Munoz-Bendix C, Steiger HJ, Kamp MA (2017) Outcome following surgical treatment of chronic subdural hematoma in the oldest-old population. Neurosurg Rev 40:527–528

    Article  PubMed  Google Scholar 

  19. Pang CH, Lee SE, Kim CH, Kim JE, Kang HS, Park CK, Paek SH, Jahng TA, Kim JW, Kim YH, Kim DG, Chung CK, Jung HW, Yoo H (2015) Acute intracranial bleeding and recurrence after bur hole craniostomy for chronic subdural hematoma. J Neurosurg 123:65–74

    Article  PubMed  Google Scholar 

  20. Park JH, Kim DH, Kim BR, Kim YW (2018) The American Society of Anesthesiologists score influences on postoperative complications and total hospital charges after laparoscopic colorectal cancer surgery. Medicine (Baltimore) 97:e0653

    Article  Google Scholar 

  21. Reponen E, Korja M, Niemi T, Silvasti-Lundell M, Hernesniemi J, Tuominen H (2015) Preoperative identification of neurosurgery patients with a high risk of in-hospital complications: a prospective cohort of 418 consecutive elective craniotomy patients. J Neurosurg 123:594–604

    Article  PubMed  Google Scholar 

  22. Rohde V, Graf G, Hassler W (2002) Complications of burr-hole craniostomy and closed-system drainage for chronic subdural hematomas: a retrospective analysis of 376 patients. Neurosurg Rev 25:89–94

    Article  PubMed  Google Scholar 

  23. Sarnthein J, Stieglitz L, Clavien PA, Regli L (2016) A patient registry to improve patient safety: recording general neurosurgery complications. PLoS One 11:e0163154

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Sjåvik K, Bartek J, Sagberg LM, Henriksen ML, Gulati S, Ståhl FL, Kristiansson H, Solheim O, Förander P, Jakola AS (2017) Assessment of drainage techniques for evacuation of chronic subdural hematoma: a consecutive population-based comparative cohort study. J Neurosurg:1–7

  25. Whitehouse KJ, Jeyaretna DS, Enki DG, Whitfield PC (2016) Head injury in the elderly: what are the outcomes of neurosurgical care? World Neurosurg 94:493–500

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank all resident and staff physicians of the department, who prospectively collected and verified the data that is the basis of the current analysis.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Bernadette Bucher.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The local ethics committee (Kantonale Ethikkommission KEK-ZH 2012–0244) approved the prospective data collection in the patient registry.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Brain trauma

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Bucher, B., Maldaner, N., Regli, L. et al. Standardized assessment of outcome and complications in chronic subdural hematoma: results from a large case series. Acta Neurochir 161, 1297–1304 (2019). https://doi.org/10.1007/s00701-019-03884-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-019-03884-7

Keywords

  • Clavien-Dindo classification system
  • Complications
  • Outcome measures
  • Chronic subdural hematoma