Introduction: Chronic subdural hematoma (CSDH) is widely treated by drainage through burr hole opening. However, whether and how preexisting comorbidities causing consciousness disturbance affect patient outcomes remains unclear.
Methods: The authors analyzed consecutive 188 patients with CSDH who were surgically treated in our institute between 2010 and 2012, and followed for more than 90 days. Mean patient age was 77.0 (range, 33 to 101) and there were 56 women. Patient outcomes including modified Rankin Scale (mRS), postoperative morbidity and mortality, and recurrence 90 days after initial surgery were analyzed according to preexisting comorbidities causing consciousness disturbance. Details of the comorbidities observed in 46 patients (28 %) were dementia (30 patients), past history of ischemic stroke (10), psychiatric disorders (3), and others (3).
Results: Background characteristics of patients with the comorbidities showed older patient age (p < 0.001), lower preoperative Glasgow Coma Scale (p < 0.001), and higher preoperative mRS (p < 0.001). Mean mRS 90 days after neurosurgical procedure was 1.2 in all the 188 patients, which was significantly higher in those with the comorbidities (p < 0.001). By one-way ANOVA with repeated measures, there existed interaction between presence of the comorbidities and mRS, and improvement of mRS was observed in smallerproportions of patients with the comorbidities (p = 0.002). By multivariate logistic regression analysis, presence of the comorbidities, patient age, reoperation for recurrence, and preoperative mRS were significantly related to poor outcomes, defined as mRS of 3 or more at 90 days after surgery. Postoperative morbidity (p < 0.01) and mortality (p < 0.01) were significantly higher in those with the comorbidities, whereas the rate of recurrence of CSDH was not significantly different.
Conclusions: Preexistence of comorbidities causing consciousness disturbance affected severity and outcomes 90 days after surgical treatment of CSDH, and the comorbidities were also correlated to aging.
Patient Care: Neurosurgeons can estimate the 90-day outcome of chronicsubdural hematomas with comorbidities causing consciousness disturbances.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of comorbidities causing consciousness disturbance on outcomes of surgery for chronic subdural hematoma, 2) Discuss, in small groups, the relationships of chronic subdural hematoma, aging and dementia, and 3) Discuss the outcomes of chronic subrudal hematomas.