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Journal of Neurosurgical Sciences 2017 Sep 28

DOI: 10.23736/S0390-5616.17.04103-0


lingua: Inglese

Prognostic factors in chronic subdural hematoma: results from a monocentric consecutive surgical series of 605 patients

Susanna BACIGALUPPI 1, 2 , Fedra GUASTALLI 1, Nicola L. BRAGAZZI 3, Alberto BALESTRINO 1, Paolo BRUZZI 4, Gianluigi ZONA 1, 2

1 Neurosurgery, Department of Neurosciences (DINOGMI), Ospedale Policlinico San Martino-IST, University of Genoa, Genoa, Italy; 2 Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy; 3 School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy


BACKGROUND: The study of age-related diseases like chronic subdural hematoma (CSDH) is of high interest, considered the general ageing of the population. This investigation aimed to identify the main clinical characteristics of CSDH patients, to evaluate the impact of the disease on quality of life, its treatment and co-morbidities/complications and to compare our data with other surgical series published over the past 5 years.
METHODS: A retrospective cohort study including all consecutive patients operated for CSDH between January 1st 2006 and December 31st 2013 at the Unit of Neurosurgery of our hospital was carried out.
RESULTS: 605 patients were included in the study (66.0% male, mean age 77.5±10.5 years). History of brain trauma was reported in 65.6 %. Common co-morbidities were hypertension (59.0%), cardiopathies (36.0%), and previous stroke (23.6%). Clotting and coagulation alterations were present in 27.2% and 17.0%, respectively. In 24.0% of cases, the hematoma was bilateral. 17.3% had more than one surgery. Length of stay was of 14.8±10.1 days. Baseline KPS, pre-surgical KPS, and KPS at discharge were 87.7±14.9, 64.9 ±19.8 and 76.7±27.2, respectively. A complete recovery was observed in 62.9% of patients. Mortality rate during hospitalization was 7.4%.
CONCLUSIONS: The knowledge of clinical and surgical factors which might impact on the clinical outcomes could help to better manage patients with CSDH, which represents a surgically ‘simple’ but, indeed, not trivial disease.

KEY WORDS: Chronic subdural hematoma - Surgery - Co-morbidities - Anti-platelets - Anticoagulants - Seizures - Outcome

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