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Predictors of mortality in chronic subdural hematoma evacuation

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Abstract

Chronic subdural hematoma (cSDH) is one of the most common types of intracranial hemorrhages, particularly in the elderly. Despite extensive research regarding cSDH diagnosis and treatment, there is conflicting data on predictors of postoperative mortality (POM). We conducted a large retrospective review 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 POM. 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 that were not extubated postoperatively had higher rates of POM. Multivariate analysis showed that only altered mental status and being not being extubated postoperatively were correlated with a higher risk of mortality. In summation, we demonstrated that altered mental status and failure to extubate were independent predictors or mortality in cSDH evacuation. Interestingly, patient age was not a significant predictor of mortality.

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References

  1. Chang CL, Sim JL, Delgardo MW, Ruan DT, Connolly ES Jr (2020) Predicting chronic subdural hematoma resolution and time to resolution following surgical evacuation. Front Neurol 11:677

    Article  PubMed  PubMed Central  Google Scholar 

  2. Posti JP, Luoto TM, Sipila JOT, Rautava P, Kyto V (2022) Prognosis of patients with operated chronic subdural hematoma. Sci Rep 12(1):7020

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  3. Rauhala M, Helen P, Seppa K, Huhtala H, Iverson GL, Niskakangas T et al (2020) Long-term excess mortality after chronic subdural hematoma. Acta Neurochir (Wien) 162(6):1467–1478

    Article  PubMed  Google Scholar 

  4. Ramachandran R, Hegde T (2007) Chronic subdural hematomas--causes of morbidity and mortality. Surg Neurol 67(4):367–372 discussion 72-3

    Article  PubMed  Google Scholar 

  5. Komiyama K, Tosaka M, Shimauchi-Ohtaki H, Aihara M, Shimizu T, Yoshimoto Y (2019) Computed tomography findings after head injury preceding chronic subdural hematoma. Neurosurg Focus 47(5):E12

    Article  PubMed  Google Scholar 

  6. Sharma R, Rocha E, Pasi M, Lee H, Patel A, Singhal AB (2020) Subdural hematoma: predictors of outcome and a score to guide surgical decision-making. J Stroke Cerebrovasc Dis 29(11):105180

    Article  PubMed  PubMed Central  Google Scholar 

  7. Blaauw J, Jacobs B, Hertog HMD, van der Gaag NA, Jellema K, Dammers R et al (2022) Mortality after chronic subdural hematoma is associated with frailty. Acta Neurochir (Wien) 164(12):3133–3141

    Article  PubMed  Google Scholar 

  8. Gonugunta V, Buxton N (2001) Warfarin and chronic subdural haematomas. Br J Neurosurg 15(6):514–517

    Article  PubMed  CAS  Google Scholar 

  9. Kothari RU, Brott T, Broderick JP, Barsan WG, Sauerbeck LR, Zuccarello M et al (1996) The ABCs of measuring intracerebral hemorrhage volumes. Stroke 27(8):1304–1305

    Article  PubMed  CAS  Google Scholar 

  10. Boccardo P, Remuzzi G, Galbusera M (2004) Platelet dysfunction in renal failure. Semin Thromb Hemost 30(5):579–589

    Article  PubMed  CAS  Google Scholar 

  11. Ball T, Oxford BG, Alhourani A, Ugiliweneza B, Williams BJ (2019) Predictors of thirty-day mortality and length of stay in operative subdural hematomas. Cureus 11(9):e5657

    PubMed  PubMed Central  Google Scholar 

  12. Wang S, Ma Y, Zhao X, Yang C, Gu J, Weng W et al (2019) Risk factors of hospital mortality in chronic subdural hematoma: A retrospective analysis of 1117 patients, a single institute experience. J Clin Neurosci 67:46–51

    Article  PubMed  Google Scholar 

  13. Ge R, Shen J (2023) Gender-specific differences in chronic subdural hematoma. J Craniofac Surg 34(2):e124–e1e8

    Article  PubMed  Google Scholar 

  14. Ruan Y, Guo Y, Kowal P, Lu Y, Liu C, Sun S et al (2019) Association between anemia and frailty in 13,175 community-dwelling adults aged 50 years and older in China. BMC Geriatrics 19(1):327

    Article  PubMed  PubMed Central  Google Scholar 

  15. Roy CN (2011) Anemia in frailty. Clin Geriatr Med 27(1):67–78

    Article  PubMed  PubMed Central  Google Scholar 

  16. Röhrig G (2016) Anemia in the frail, elderly patient. Clin Interv Aging 11:319–326

    Article  PubMed  PubMed Central  Google Scholar 

  17. Chaves PHM, Semba RD, Leng SX, Woodman RC, Ferrucci L, Guralnik JM et al (2005) Impact of anemia and cardiovascular disease on frailty status of community-dwelling older women: the women's health and aging studies I and II. J Gerontol: Series A 60(6):729–735

    Article  Google Scholar 

  18. Chiappini A, Greuter L, Mariani L, Guzman R, Soleman J (2021) Mortality and outcome in patients older than 80 years of age undergoing burr-hole drainage of chronic subdural hematoma. World Neurosurg 150:e337–ee46

    Article  Google Scholar 

  19. Batchelor JS, Grayson A (2012) A meta-analysis to determine the effect of anticoagulation on mortality in patients with blunt head trauma. Br J Neurosurg 26(4):525–530

    Article  PubMed  Google Scholar 

  20. Baraniskin A, Steffens C, Harders A, Schmiegel W, Schroers R, Spangenberg P (2014) Impact of pre-hospital antithrombotic medication on the outcome of chronic and acute subdural hematoma. J Neurol Surg A Cent Eur Neurosurg 75(1):31–36

    Article  PubMed  Google Scholar 

  21. Alford EN, Rotman LE, Erwood MS, Oster RA, Davis MC, Pittman HBC et al (2019) Development of the Subdural Hematoma in the Elderly (SHE) score to predict mortality. J Neurosurg 132(5):1616–1622

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank all the staff at the Montefiore Department of Neurosurgery and Anesthesiology for their help and cooperation.

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Authors and Affiliations

  1. Department of Neurosurgery, Montefiore Medical Center, Bronx, NY, 10461-1900, USA

    Rahman Sayed, Suzanne Gross, Linda Nie, Gagandeep Mudhar, Mustufa Babar, Mudaser Basam, Reza Yassari & Yaroslav Gelfand

  2. Department of Neurosurgery, Stanford School of Medicine, Stanford, CA, 94305, USA

    Aroosa Zamarud

  3. Department of Anesthesiology, Montefiore Medical Center, Bronx, NY, 10461-1900, USA

    Matthias Eikermann, Samuel Rupp & Jinu Kim

Authors
  1. Rahman Sayed
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  2. Suzanne Gross
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  3. Aroosa Zamarud
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  4. Linda Nie
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  5. Gagandeep Mudhar
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  6. Matthias Eikermann
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  7. Samuel Rupp
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  8. Jinu Kim
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  9. Mustufa Babar
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  10. Mudaser Basam
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  11. Reza Yassari
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  12. Yaroslav Gelfand
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Rahman Sayed, Aroosa Zamarud, and Suzanne Gross. Mustufa Babar, Mudaser Basam, Rafael De La Garza Ramos, Ryan Holland, Jinu Kim, Samuel Rupp, Matthias Eikermann, Linda Nie, and Gagandeep Mudhar assisted in data collection. The project was supervised by Yaroslav Gelfand and Reza Yessari and they contributed in editing the final manuscript. The first draft of the manuscript was written by Rahman Sayed and all authors commented on previous versions of the manuscript. Linda Nie and Gagandeep Mudhar assisted in editing the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Rahman Sayed.

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Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Albert Einstein College of Medicine (IRB: 2022-13861 2/23/2022).

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No authors on this manuscript have any competing interests to declare and this declaration is not applicable.

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Previously presented as a poster at the AANS Annual Scientific Meeting, April 21 to 24, 2023, Los Angeles, California.

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Sayed, R., Gross, S., Zamarud, A. et al. Predictors of mortality in chronic subdural hematoma evacuation. Neurosurg Rev 46, 318 (2023). https://doi.org/10.1007/s10143-023-02213-y

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