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  • Independent Risk Factors and Risk Factor Selection Modeling for the Recurrence of Chronic Subdural Hematomas

    Final Number:

    Andrew Jack MD; Cian O'Kelly MD, MSc, FRCSC; Jay Max Findlay MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Chronic subdural haematoma (CSDH) recurrence remains a challenge with reported rates approaching 20%. This study investigates independent factors predicting recurrence in a large cohort of CSDH patients.

    Methods: We retrospectively reviewed 331 consecutive operative CSDH cases between 2005-2009. Univariate, multivariate, and statistical selection modeling was completed identifying factors influencing recurrence requiring repeat drainage within 2-months. A model was developed to identify and quantify patients’ recurrence risk based on age, haematoma volume, and presence of loculations.

    Results: The majority of patients were male (80.66%). Mean post-operative haematoma volume was 63.55cc. Factors associated with higher post-operative haematoma volume were loculated (septated) CSDHs, pre-operative volume, midline shift, age, and atrophy. All factors except midline shift were independently predictive of larger post-operative haematoma. The recurrence rate for repeat drainage was 12%. Loculated CSDHs was the only independent predictor for reoperation. A scoring system was created to quantify recurrence. Higher recurrence rates were found amongst higher patient scores. Scores of 0, 1, 2, and 3 resulted in recurrence rates of 4.76%, 11.72%, 13.83%, and 20.69%, respectively.

    Conclusions: Haematoma volume, age, and presence of loculations are found to most strongly influence operative recurrence. A scoring model for identifying higher risk patients for recurrence was developed.

    Patient Care: Identifying patients at higher risk of CSDH recurrence may change clinical practice by alerting the neurosurgical team as to who should be followed more closely clinically and/or radiologically.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Recognize independent risk factors of CSDH recurrence 2) Identify and stratify patients' risk of CSDH recurrence based on the presented scoring model


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