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



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.


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.


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.


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.

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Fig. 1
Fig. 2



American Society of Anesthesiology Classification of Perioperative Risk


Body mass index


Charlson Comorbidity Index


Clavien-Dindo grading system

cSDH :

Chronic subdural hematoma


Glasgow Coma Scale


Interquartile range


Karnofsky Performance Status

mRS :

Modified Rankin Scale


National Institute of Health Stroke Scale

SD :

Standard deviation


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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.

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Correspondence to Bernadette Bucher.

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The authors declare that they have no conflict interests.

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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.

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

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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).

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