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Publication Detail
Outcomes following surgery in subgroups of comatose and very elderly patients with chronic subdural hematoma
  • Publication Type:
    Journal article
  • Publication Sub Type:
    Article
  • Authors:
    Christopher E, Poon MTC, Glancz LJ, Hutchinson PJ, Kolias AG, Brennan PM, Afshari FT, Ahmed AI, Alli S, Al-Mahfoudh R, Bal J, Belli A, Borg A, Bulters D, Carleton-Bland N, Chari A, Coope D, Coulter IC, Cowie CJ, Critchley G, Dambatta S, D Aquino D, Dhamija B, Dobson G, Fam MD, Gray WP, Gregson BA, Grover PJ, Halliday J, Hamdan A, Hill CS, Jamjoom AAB, Joannides AJ, Jones TL, Joshi SM, Kailaya-Vasan A, Karavasili V, Khan SA, King AT, Kuenzel A, Livermore LJ, Lo W, Marcus HJ, Martin J, Matloob S, Mitchell P, Mowle D, Narayanamurthy H, Nelson RJ, Ngoga D, Noorani I, O Reilly G, Othman H, Owusu-Agyemang K, Manjunath Prasad KS, Plaha P, Pollock J, Prasad KS, Price R, Pringle C, Ray A, Reaper J, Scotton W, Shapey J, Simms N, Smith S, Statham P, Steele L, St George J, Stovell MG, Tarnaris A, Teo M, Thomson S, Thorne L, Vintu M, Whitfield P, Wilson M, Wilby M, Woodfield J, Zaben M
  • Publisher:
    Springer Nature
  • Publication date:
    01/06/2019
  • Journal:
    Neurosurgical Review
  • Status:
    Published online
  • Print ISSN:
    0344-5607
  • Language:
    English
  • Keywords:
    Chronic subdural hematoma, Very elderly, Comatose, Outcome, Surgery
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.
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UCL Queen Square Institute of Neurology
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Neurodegenerative Diseases
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