Two-day Hospital Stay Surgery for Chronic Subdural Hematoma

Objective: Neuroendoscopic treatment is an alternative therapeutic strategy for the treatment of septate chronic subdural hematoma (sCSDH). However, the safety and efficacy of this strategy remain controversial. We compared the clinical outcomes of neuroendoscopic treatment with those of standard (large bone flap) craniotomy for sCSDH reported in our center. Furthermore, the safety and efficacy of the neuroendoscopic treatment procedure for sCSDH were evaluated.Methods: We retrospectively collected the clinical data of 43 patients (37 men and six women) with sCSDH who underwent either neuroendoscopic treatment or standard (large bone flap) craniotomy, such as sex, age, smoking, drinking, medical history, use of antiplatelet drugs, postoperative complications, sCSDH recurrence, length of hospital stay, and postoperative hospital stay. We recorded the surgical procedures and the neurological function recovery prior to surgery and 6 months following the surgical treatment.Results: The enrolled patients were categorized into neuroendoscopic treatment (n = 23) and standard (large bone flap) craniotomy (n = 20) groups. There were no differences in sex, age, smoking, drinking, medical history, antiplatelet drug use, postoperative complications, and sCSDH recurrence between the two groups (p > 0.05). However, the patients in neuroendoscopic treatment group had a shorter length of total hospital stay and postoperative hospital stay as compared with the standard craniotomy group (total hospital stay: 5.26 ± 1.89 vs. 8.15 ± 1.04 days, p < 0.001; postoperative hospital stay: 4.47 ± 1.95 vs. 7.96 ± 0.97 days, p < 0.001). The imaging and Modified Rankin Scale at the 6-month follow-up were satisfactory, and no sCSDH recurrence was reported in the two groups.Conclusions: The findings of this study indicate that neuroendoscopic treatment is safe and effective for sCSDH; it is minimally invasive and could be clinically utilized.

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Comparative Epidemiological Profile of Elderly and Non-elderly Patients Operated on Chronic Subdural Hematoma

JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA ◽

10.22290/jbnc.v31i3.1862 ◽

2020 ◽

Vol 31 (3) ◽

pp. 191-200

Author(s):

Mauro Takao Marques Suzuki ◽

Mirian Conceição Moura ◽

Luiz Augusto Casulari

Keyword(s):

Elderly Patients ◽

Hospital Stay ◽

Subdural Hematoma ◽

Young Patients ◽

Case Series ◽

Chronic Subdural Hematoma ◽

Retrospective Case ◽

Group 2 ◽

Epidemiological Profile ◽

Group 1

Background: Traumatic brain injury is a severe condition in elder patients. Young patients usually have better prognosis compared to the elderly. Head trauma might represent an initial event that leads to death in this population. Objective: To evaluate was to evaluate the epidemiological profile of elderly patients operated on chronic subdural hematoma (CSDH). Methods: This is a descriptive, observational and retrospective case series. The use of anticoagulant and antiplatelet drugs, length of hospital stay, mortality and CSDH recurrence, among others, were the evaluated variables. Results: A total of 328 patients had their records assessed. Patients younger than 60 years formed group 1 (n=102) and those older than 60 years formed group 2 (n=226). Ageing is correlated to higher mortality. Acetylsalicylic acid and anticoagulant drugs usage in both groups did not correlate to worse outcomes. In group 2, there were 33 deaths during hospital stay (14.6%) and 14 deaths within one year after surgery (6.2%). Only one death was registered in group 1. Conclusion: Ageing is an important isolated prognostic factor.

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Analysis of risk factors for prolong hospitalization in chronic subdural hematoma undergoing single burr hole and drainage

Nepal Journal of Neuroscience ◽

10.3126/njn.v18i1.34938 ◽

2021 ◽

Vol 18 (1) ◽

pp. 39-44

Author(s):

Sumit Joshi ◽

Prakash Paudel ◽

Damber Bikram Shah ◽

Prasanna Karki ◽

Gopal Raman Sharma

Keyword(s):

Hospital Stay ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Burr Hole ◽

Favorable Outcome ◽

Chi Square ◽

Neurosurgical Procedure ◽

Early Outcome ◽

Anticoagulant Drugs ◽

Chi Square Test

Introduction Single burr hole surgery for Chronic subdural hematoma (CSDH) is commonly performed neurosurgical procedure with >90% favorable outcome and less hospital stay. However, sometimes hospital stay may be prolonged due to associated prognostic factors, even in patients with favorable outcome. This study aims to analyze the early outcome of single burr hole and drainage surgery and factors that may be associated with prolong hospitalization. Materials and method A retrospective analysis of the patients who underwent single burr hole and drainage for CSDH from sept 2017 to may 2020 in Nepal Mediciti hospital. The patients with B/L CSDH, who underwent double burr hole and drainage or craniotomy evacuation or conservatively managed patients were excluded from the study. Early outcome was assessed using Glasgow outcome score at 7 days. Effect of use of antiplatelet/ anticoagulant drugs, age, comorbidity, preoperative Glasgow coma score on number of hospital stay was analyzed. Chi-square test was used for statistical analysis in SPSS version 25. Results Out of 85 patients, 73 were male. Mean age was 63.8 years. Early outcome in 7 days was favorable with GOS (4-5) in 90.6%. The use of antiplatelet or anticoagulant drugs was more common amongst patients with age > 70 years (p=0.01). The number of hospital stay was associated with age (p=0.00), antiplatelet or anticoagulant drugs (p=0.00), comorbidities (p=0.001), preoperative GCS(P=0.001) and GOS at 7 days (p=0.001). Conclusion Single burr hole and drainage surgery for CSDH mostly produce favorable outcome. The use of antiplatelet or anticoagulant drugs is more common in patients above 70 years. Age, antiplatelet or anticoagulant drugs, comorbidities, preoperative GCS, GOS at 7 days are related with longer hospital stay.

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Outcome of Chronic Subdural Hematoma Treated with Single Burr Hole Under Local Anesthesia

Ethiopian Journal of Health Sciences ◽

10.4314/ejhs.v30i1.13 ◽

2020 ◽

Vol 30 (1) ◽

Author(s):

Abebe Mersha ◽

Sahlu Abat ◽

Tsegaye Temesgen ◽

Abebe Nebyou

Keyword(s):

Hospital Stay ◽

Local Anesthesia ◽

Subdural Hematoma ◽

Addis Ababa ◽

Chronic Subdural Hematoma ◽

Postoperative Outcome ◽

The Elderly ◽

Burr Hole ◽

Cross Sectional ◽

Burr Hole Evacuation

BACKGROUND: Chronic subdural hematoma (CSDH) is a common condition encountered in daily neurosurgical practice usually affecting the elderly population. Various surgical procedures have been used for the evacuation of hematoma in patients with CSDH. The objective of this paper was to study the postoperative outcome of patients who were operated for CSDH and to describe the easy, safest and effective procedure that can be performed at primary level hospitals.METHODS: Institutional based cross-sectional retrospective study was conducted among patients operated for CSDH from January 1, 2012 to December 31, 2015 at Teklehaymanot General Hospital, a private hospital in Addis Ababa, Ethiopia. Descriptive statistics, using SPSS version 20, was used to determine the postoperative outcomes including hospital stay, complications and recurrence rate.RESULTS: Of the 195 charts reviewed, 70.3% were of males, with M: F ratio of 2.4:1. 68.2% of patients being above the age of 55 years with a mean age at presentation of 57.63. The most common presenting symptom was headache followed by extremity weakness. The diagnosis of CSDH was made with either head CT scan or MRI. Forty one percent of patients had a left side hematoma and 48(24.6%) patients had bilateral CSDH. All patients were operated with a single burr hole evacuation under local anesthesia and postoperative subdural closed system drainage by a single neurosurgeon. The mean hospital stay was 3.68±2.6 days. The postoperative outcome was assessed using the Glasgow Outcome Score, and 95.9% of the patients reported good recovery. Thirteen (6.6%) patients were operated twice for recurrence, and there were four deaths.CONCLUSIONS: Single burr hole craniostomy is an easy, safe and effective technique for the treatment of CSDH.

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Local anesthesia versus general anesthesia for evacuation of chronic subdural hematoma in elderly patients above 70 years old

Surgical Neurology International ◽

10.25259/sni_425_2021 ◽

2022 ◽

Vol 13 ◽

pp. 13

Author(s):

Ahmed Ashry ◽

Hieder Al-Shami ◽

Medhat Gamal ◽

Ahmed M Salah

Keyword(s):

Elderly Patients ◽

Hospital Stay ◽

Local Anesthesia ◽

Subdural Hematoma ◽

Complication Rate ◽

Operative Time ◽

Chronic Subdural Hematoma ◽

Length Of Hospital Stay ◽

Group A ◽

Group B

Background: The aim of this study was to assess the safety and efficacy of chronic subdural hematoma (CSDH) evacuation by two burr-hole craniostomies under local versus general anesthesia (GA) in elderly patients over 70 years. Methods: This retrospective study included 45 patients with CSDH aged over 70 years old treated from March 2018 to April 2020. The cases were subdivided into Group A (n = 22) that underwent evacuation under local anesthesia and Group B (n = 23) that was treated under GA. Patients’ demographics and history of comorbidities were recorded. Variables including pre- and post-operative neurological status and Markwalder’s score, complication rate, operative time, and length of hospital stay were evaluated. Results: The mean and standard deviation of patients’ age of groups (A) and (B) were 74.3 ± 2.5 and 73.2 ± 1.7 years, respectively. Postoperative Glasgow Coma Scale of group (A) was statistically higher than Group B at postoperative day 1 (P = 0.01). Operative time was statistically shorter in Group A than B (P < 0.0001). The length of hospital stay was found to be longer in group (B) than (A) (P = 0.0001). The complication rate was found to be higher in group (B) than (A) (P = 0.044). Conclusion: Evacuation of CSDH under local anesthesia in elderly patients over 70 years is effective, safe, and economic with less complication rate than the traditional technique with GA.

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National randomized clinical trial on subdural drainage time after chronic subdural hematoma evacuation

Journal of Neurosurgery ◽

10.3171/2021.10.jns211608 ◽

2021 ◽

pp. 1-8

Keyword(s):

Hospital Stay ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Length Of Hospital Stay ◽

Burr Hole ◽

Drainage Time ◽

Postoperative Length ◽

The Mean ◽

Burr Hole Evacuation

OBJECTIVE Placement of a subdural drain reduces recurrence and death after evacuation of chronic subdural hematoma (CSDH), but little is known about optimal drainage duration. In the present national trial, the authors investigated the effect of drainage duration on recurrence and death. METHODS In a randomized controlled trial involving all neurosurgical departments in Denmark, patients treated with single burr hole evacuation of CSDH were randomly assigned to 24 hours or 48 hours of postoperative passive subdural drainage. Follow-up duration was 90 days, and the primary study outcome was recurrent hematoma requiring reoperation. Secondary outcome was death. In addition, complications and length of hospital stay were recorded and analyzed. RESULTS Of the 420 included patients, 212 were assigned 24-hour drainage and 208 were assigned 48-hour drainage. The recurrence rate was 14% in the 24-hour group and 13% in the 48-hour group. Four patients died in the 24-hour group, and 8 patients died in the 48-hour group; this difference was not statistically significant. The ORs (95% CIs) for recurrence and mortality (48 hours vs 24 hours) were 0.94 (0.53–1.66) and 2.07 (0.64–7.85), respectively, in the intention-to-treat analysis. The ORs (95% CIs) for recurrence and mortality per 1-hour increase in drainage time were 1.0005 (0.9770–1.0244) and 1.0046 (0.9564–1.0554), respectively, in the as-treated sensitivity analysis that used the observed drainage times instead of the preassigned treatment groups. The rates of surgical and drain-related complications, postoperative infections, and thromboembolic events were not different between groups. The mean ± SD postoperative length of hospital stay was 7.4 ± 4.3 days for patients who received 24-hour drainage versus 8.4 ± 4.9 days for those who received 48-hour drainage (p = 0.14). The mean ± SD postoperative length of stay in the neurosurgical department was significantly shorter for the 24-hour group (2 ± 0.9 days vs 2.8 ± 1.6 days, p < 0.001). CONCLUSIONS No significant differences in the rates of recurrent hematoma or death during 90-day follow-up were identified between the two groups that randomly received either 24- or 48-hour passive subdural drainage after burr hole evacuation of CSDH.

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Single versus double burr-hole drainage for chronic subdural hematoma: A study of relevant prognostic factors conducted in Pakistan

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.4.543 ◽

2019 ◽

Vol 35 (4) ◽

Cited By ~ 1

Author(s):

Habib Ullah Khan ◽

Khaula Atif ◽

Gholamheidar Teimori Boghsani

Keyword(s):

Prognostic Factors ◽

Hospital Stay ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Burr Hole ◽

Military Hospital ◽

P Value ◽

Recurrence Rates ◽

Significant Difference ◽

Single Versus

Objective: To compare the efficacy of single versus double burr-hole for drainage of chronic subdural hematoma, keeping in consideration pertinent demographic, pre and postoperative associations. Methods: A prospective cohort study carried out in Combined Military Hospital, Multan, (December 2016-August 2018), on adults with diagnosed chronic subdural hematoma (CSDH); being segregated by randomized control trial, non-probability purposive sampling into Group-A and Group-B (who underwent single and double burr-holes for CSDH-drainage respectively). Utilizing SPSS-21, data expressed as frequencies/percentages and mean± standard deviation (SD) and cross-tabulated; p-value <0.05 was taken as significant. Results: Age and GCS scores were 62±13.694 (range 38-94) and 11.00±3.350 (range 3-15) respectively, males being 40(66.7). Post-operative fatality was Nil, while 8(13.3%) and 14(23.3%) had post-operative seizures and recurrence of hematoma respectively. There was no significant association between type of burr-hole and hospital stay (p 0-884), seizures (p 0.448) or recurrence (p 0.542). Hospital stay (p<0.000) and seizures (p-0.005) were inversely proportional to GCS scores on presentation. Recurrence rates were not affected by age (p-0 .175) or gender (p-0 .281). Conclusion: There was no significant difference between outcomes of single and double burr-hole surgeries; the former must be preferred because of lesser iatrogenic trauma. GCS-score on presentation was validated as a negative association to anticipate post-operative outcomes. doi: https://doi.org/10.12669/pjms.35.4.543 How to cite this:Khan HU, Atif K, Boghsani GT. Single versus double burr-hole drainage for chronic subdural hematoma: A study of relevant prognostic factors conducted in Pakistan. Pak J Med Sci. 2019;35(4):---------. doi: https://doi.org/10.12669/pjms.35.4.543 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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