Clinical Analysis of Risk Factors for Recurrence in Patients with Chronic Subdural Hematoma Undergoing Burr Hole Trephination

Background: We routinely measured the exact chronic subdural hematoma (CSDH) volume during single burr hole surgery. To date, several risk factors have been reported for CSDH recurrence, including sex, hematoma volume and degree of midline shift calculated from computed tomography, use of anticoagulants or antiplatelet medications, and alcohol consumption habits. The aim of this study was to clarify whether hematoma volume, in conjunction with other factors, can predict recurrence. Methods: We retrospectively reviewed the clinical data of 194 consecutive patients with CSDH who underwent single burr hole surgery. The risk factors for recurrence were analyzed based on patients’ sex, age, bilaterality, existence of apparent trauma history, exact intraoperative hematoma volume, and various clinical factors, including preoperative anticoagulant/antiplatelet intake. Results: Recurrence occurred in 22 patients (11.3%). Multivariate logistic regression analysis revealed that intraoperative hematoma volume was an independent risk factor for CSDH recurrence (odds ratio [OR], 1.01; 95% confidence interval [CI], 1.01–1.02, P < 0.001), in addition to sex (male) (OR 9.25; 95% CI, 1.00–84.8; P = 0.049) and diabetes mellitus (DM) (OR: 3.97, 95% CI, 1.34–11.7, P = 0.013). Based on receiver operating characteristics analysis, the cutoff value of the hematoma volume predicting CSDH recurrence was 150 ml (sensitivity and specificity of 72.7% and 72.1%, respectively; area under the curve: 0.7664, 95% CI: 0.654–0.879, P < 0.001). Of these, a hematoma volume ≥150 mL was the strongest independent risk factor for recurrence according to multiple regression (OR: 8.98, 95% CI: 2.73–29.6, P < 0.001) and Cox regression analysis (hazard ratio: 3.05, 95% CI: 1.18–7.87, log-rank P = 0.0046, P = 0.021). Follow-up periods after surgery were significantly longer for cases with recurrence than for non-recurrence cases (24.8 ± 11.5 vs. 15.9 ± 9.7 days), and the recurrence prediction cutoff value was 17 days, with a sensitivity and specificity of 83.1% and 68.2%, respectively (AUC: 0.7707, 95% CI: 0.6695–0.8720, P < 0.001). Conclusion: Intraoperative hematoma volume could be a predictive value for CSDH recurrence.

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Clinical Analysis of Risk Factors Related to Recurrent Chronic Subdural Hematoma

Journal of Korean Neurosurgical Society ◽

10.3340/jkns.2008.43.1.11 ◽

2008 ◽

Vol 43 (1) ◽

pp. 11 ◽

Cited By ~ 77

Author(s):

Byung-Soo Ko ◽

Jung-Kil Lee ◽

Bo-Ra Seo ◽

Sung-Jun Moon ◽

Jae-Hyoo Kim ◽

...

Keyword(s):

Risk Factors ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Clinical Analysis

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Predictive factors for recurrence and clinical outcomes in patients with chronic subdural hematoma

Journal of Neurosurgery ◽

10.3171/2016.8.jns16867 ◽

2017 ◽

Vol 127 (5) ◽

pp. 1117-1125 ◽

Cited By ~ 16

Author(s):

Myung-Hoon Han ◽

Je il Ryu ◽

Choong Hyun Kim ◽

Jae Min Kim ◽

Jin Hwan Cheong ◽

...

Keyword(s):

Risk Factors ◽

Clinical Outcomes ◽

Subdural Hematoma ◽

Repeated Measures ◽

Proportional Hazards ◽

Medical Center ◽

Chronic Subdural Hematoma ◽

Cox Proportional Hazards ◽

Risk Factors For Recurrence

OBJECTIVEChronic subdural hematoma (CSDH) is a common type of intracranial hemorrhage in elderly patients. Many studies have suggested various factors that may be associated with the recurrence of CSDH. However, the results are inconsistent. The purpose of this study was to determine the associations among patient factors, recurrence, and clinical outcomes of CSDH after bur hole surgery performed during an 11-year period at twin hospitals.METHODSKaplan-Meier analysis was performed to evaluate the risk factors for CSDH recurrence. Univariate and multivariate Cox proportional hazards regression analyses were used to calculate hazard ratios with 95% CIs for CSDH recurrence based on many variables. One-way repeated-measures ANOVA was used to assess the differences in the mean modified Rankin Scale score between categories for each risk factor during each admission and at the last follow-up.RESULTSThis study was a retrospective analysis of 756 consecutive patients with CSDH who underwent bur hole surgery at the Hanyang University Medical Center (Seoul and Guri) between January 1, 2004, and December 31, 2014. During the 6-month follow-up, 104 patients (13.8%) with recurrence after surgery for CSDH were identified. Independent risk factors for recurrence were as follows: age > 75 years (HR 1.72, 95% CI 1.03–2.88; p = 0.039), obesity (body mass index ≥ 25.0 kg/m2), and a bilateral operation.CONCLUSIONSThis study determined the risk factors for recurrence of CSDH and their effects on outcomes. Further studies are needed to account for these observations and to determine their underlying mechanisms.

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