Introduction: Chronic subdural hematomas are a growing epidemiological concern that confers increased morbidity and mortality and which often requires neurosurgical expertise. Here, we studied 194 cases of chronic subdural hematoma and subsequent management results within a 3 year period at a single institution.
Methods: The management of chronic subdural hematomas was retrospectively examined at a single institution from 2011 to 2014. Management consisted of burrhole drainage, subdural evacuation port system, or craniotomy. Average length of stay, 30 day readmission, and rate of return to OR were documented.
Results: From 2011 to 2014, 133 patients were treated with burrhole drainage, 56 patients were treated with craniotomy, and 5 patients were treated with a subdural evacuating port system (SEPS). The average length of stay for burr hole drainage was 4.3 +/- 2.2 days, which was shorter than that for both craniotomy (7.5 +/- 5.1 days) and SEPS (6.9 +/- 5.1 days). Of patients in the burrhole drainage group, 12 (9%) returned to the OR for repeat drainage (10) or craniotomy (2). Craniotomy was related to a 5.3% risk of need for reoperation, whereas 2 of the patients in the SEPS group required additional burr hole drainage (40%).
Conclusions: Overall length of stay was increased for patients with chronic subdural hematomas undergoing craniotomy and SEPS; however, need for reoperation was increased for patients undergoing burrhole drainage versus for craniotomy. Selection of neurosurgical procedure in this series was mainly influenced by patient characteristics and radiographic findings, however these data can be used to better inform our practice in the management of subdural hematomas. It is essential to continue to investigate modalities that will minimize length of stay and need for return to OR in patients with chronic subdural hematomas, given the expanding prevalence of oral anticoagulants and the aging population.
Patient Care: Studying the complication rates and length of stay requirements for patients with chronic subdural hematomas will provide data that can better inform decisions regarding choice of neurosurgical procedure.
Learning Objectives: 1) Recognize the importance of improving management of chronic subdural hematomas in the current and future demographic milieu;
2) To utilize retrospective data in order to improve clinical decision-making in the surgical treatment of chronic subdural hematomas.