Christopher, E; Poon, MTC; Glancz, LJ; Hutchinson, PJ; Kolias, AG; Brennan, PM; British Neurosurgical Trainee Research Collaborative (BNTRC)
(2019)
Outcomes following surgery in subgroups of comatose and very elderly patients with chronic subdural hematoma.
Neurosurg Rev, 42 (2).
pp. 427-431.
ISSN 1437-2320
https://doi.org/10.1007/s10143-018-0979-4
SGUL Authors: Jones, Timothy Lloyd
Abstract
Increasing age and lower pre-operative Glasgow coma score (GCS) are associated with worse outcome after surgery for chronic subdural haematoma (CSDH). Only few studies have quantified outcomes specific to the very elderly or comatose patients. We aim to examine surgical outcomes in these patient groups. We analysed data from a prospective multicentre cohort study, assessing the risk of recurrence, death, and unfavourable functional outcome of very elderly (≥ 90 years) patients and comatose (pre-operative GCS ≤ 8) patients following surgical treatment of CSDH. Seven hundred eighty-five patients were included in the study. Thirty-two (4.1%) patients had pre-operative GCS ≤ 8 and 70 (8.9%) patients were aged ≥ 90 years. A higher proportion of comatose patients had an unfavourable functional outcome (38.7 vs 21.7%; p = 0.03), although similar proportion of comatose (64.5%) and non-comatose patients (61.8%) functionally improved after surgery (p = 0.96). Compared to patients aged < 90 years, a higher proportion of patients aged ≥ 90 years had unfavourable functional outcome (41.2 vs 20.5%; p < 0.01), although approximately half had functional improvement following surgery. Mortality risk was higher in both comatose (6.3 vs 1.9%; p = 0.05) and very elderly (8.8 vs 1.1%; p < 0.01) groups. There was a trend towards a higher recurrence risk in the comatose group (19.4 vs 9.5%; p = 0.07). Surgery can still provide considerable benefit to very elderly and comatose patients despite their higher risk of morbidity and mortality. Further research would be needed to better identify those most likely to benefit from surgery in these groups.
Item Type: |
Article
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Additional Information: |
© The Author(s) 2018
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
Keywords: |
Chronic subdural hematoma, Comatose, Outcome, Surgery, Very elderly, Age Factors, Aged, Aged, 80 and over, Cohort Studies, Coma, Female, Glasgow Coma Scale, Hematoma, Subdural, Chronic, Humans, Male, Middle Aged, Recurrence, Treatment Outcome, British Neurosurgical Trainee Research Collaborative (BNTRC), Humans, Hematoma, Subdural, Chronic, Coma, Recurrence, Treatment Outcome, Glasgow Coma Scale, Cohort Studies, Age Factors, Aged, Aged, 80 and over, Middle Aged, Female, Male, Chronic subdural hematoma, Very elderly, Comatose, Outcome, Surgery, Neurology & Neurosurgery, 1103 Clinical Sciences, 1109 Neurosciences |
SGUL Research Institute / Research Centre: |
Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) |
Journal or Publication Title: |
Neurosurg Rev |
ISSN: |
1437-2320 |
Language: |
eng |
Dates: |
Date | Event |
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1 June 2019 | Published | 21 April 2018 | Published Online | 9 April 2018 | Accepted |
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Publisher License: |
Creative Commons: Attribution 4.0 |
Projects: |
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PubMed ID: |
29679178 |
Web of Science ID: |
WOS:000467137500021 |
![](http://static.pubmed.gov/portal/portal3rc.fcgi/2745237/img/27842) |
Go to PubMed abstract |
URI: |
https://openaccess.sgul.ac.uk/id/eprint/112352 |
Publisher's version: |
https://doi.org/10.1007/s10143-018-0979-4 |
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