Introduction: The purpose of this study was to describe cases of patients who presented with subdural hematomas at a high-volume academic medical center. Cases that were solely acute subdural hematomas were excluded, as trauma is frequently the cause of acute bleeding.
Methods: Medical records from Brigham and Women’s Hospital were retrospectively reviewed. 322 patients from 2008 to 2014 who had undergone evacuation of a subdural hematoma were included in this study. Demographic information, surgery characteristics, and postoperative complications were evaluated. Multivariate linear regression evaluated the association of these variables with re-operation.
Results: Our re-operation rate was roughly 13%. Patients who had a past medical history that included some type of cancer were 2.3 times more likely to need a re-operation. Patients who presented with a lack of preoperative headache were 3.2 times more likely to need a re-operation; those who presented with facial weakness were 3.1 times more likely. A postoperative reduction of the hematoma size by 40% or less had an odds ratio of 2.2. Those who had an acute component to their hematoma were 2.1 times more likely to need a re-operation. The type of surgery and the usage of drains were not found to be correlated with the need for a repeated evacuation.
Conclusions: Subdural hematomas are commonly encountered in neurosurgery, and much controversy exists in the literature regarding predictors of re-operation. We present our experiences here, but additional data is needed to determine whether our preliminary results will continue to hold.
Patient Care: Reaccumulation of subdural hematoma often necessitates re-operation. By developing a model and potentially identifying predictors of re-operation, we can better establish guidelines for medically managing our patients.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of management of subdural hematomas, 2) Develop a sense of the subdural cases presented at Brigham and Women's Hospital, 3) Discuss possible predictors of re-operation