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Outcomes following surgery in subgroups of comatose and very elderly patients with chronic subdural hematoma.

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

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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
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:
DateEvent
1 June 2019Published
21 April 2018Published Online
9 April 2018Accepted
Publisher License: Creative Commons: Attribution 4.0
Projects:
Project IDFunderFunder ID
II-C5-0715-20005Department of Healthhttp://dx.doi.org/10.13039/501100000276
12/35/57Department of Healthhttp://dx.doi.org/10.13039/501100000276
G1002277Medical Research Councilhttp://dx.doi.org/10.13039/501100000265
HTA/13/15/02Department of Healthhttp://dx.doi.org/10.13039/501100000276
602150European Union Seventh Framework ProgramUNSPECIFIED
NIHR-RP-R3-12-013Department of Healthhttp://dx.doi.org/10.13039/501100000276
G0502030Medical Research Councilhttp://dx.doi.org/10.13039/501100000265
G9439390Medical Research Councilhttp://dx.doi.org/10.13039/501100000265
MR/L010305/1Medical Research Councilhttp://dx.doi.org/10.13039/501100000265
G0601025Medical Research Councilhttp://dx.doi.org/10.13039/501100000265
G0600986Medical Research Councilhttp://dx.doi.org/10.13039/501100000265
PubMed ID: 29679178
Web of Science ID: WOS:000467137500021
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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