Advanced

Does time from diagnostic CT until surgical evacuation affect outcome in patients with chronic subdural hematoma?

Zolfaghari, Shaian LU ; Ståhl, Nils LU and Nittby Redebrandt, Henrietta LU (2018) In Acta Neurochirurgica 160(9). p.1703-1709
Abstract

Background: Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions. Patients diagnosed with CSDH’s are often planned for subacute surgery. This means that time from diagnostic CT scan until actual surgery might often be prolonged. There are no previous studies that highlight the effect of delayed intervention in this population. Method: Patients that underwent surgical evacuation for a CSDH at Skåne University Hospital between 1 January 2015 and 31 December 2016 were included in this retrospective cohort study (n = 179). The primary aim was to determine if time from initial diagnosis by head-CT until surgical evacuation had a significant effect on outcome. The following was assessed by mortality,... (More)

Background: Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions. Patients diagnosed with CSDH’s are often planned for subacute surgery. This means that time from diagnostic CT scan until actual surgery might often be prolonged. There are no previous studies that highlight the effect of delayed intervention in this population. Method: Patients that underwent surgical evacuation for a CSDH at Skåne University Hospital between 1 January 2015 and 31 December 2016 were included in this retrospective cohort study (n = 179). The primary aim was to determine if time from initial diagnosis by head-CT until surgical evacuation had a significant effect on outcome. The following was assessed by mortality, re-operation, number of days spent in hospital, discharge to home/institution, and functional outcome assessed by GOS. Secondary aims were to evaluate the effect of NOAC, vitamin K antagonists, and antiplatelet drugs on time from CT to surgery and re-operation frequency. Results: Mean time from diagnostic CT scan until surgery was 76 h. No significant relationship was found between time from CT to surgical evacuation and number of days spent in hospital, discharge to own home/institution, 1-year mortality, or outcome assessed by GOS at discharge from hospital. The clear majority (95.5%) of the patients were GCS ≥ 13 pre-operatively. No correlation could be seen between use of NOAC, vitamin K antagonists, or antiplatelet drugs regarding the risk for reoperation within 6 months, and no correlation between the use of these agents and time from CT to surgery. The 30-day mortality was too low to draw any statistically significant conclusions (n = 4). Conclusion: In this retrospective cohort study, we could conclude that a delay from initial diagnosis confirming a CSDH to surgical evacuation had no negative effect on outcome when surgery was performed within the time frames and on patients with pre-operatively favorable GCS scores (≥ 13) outlined in our study.

(Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Chronic subdural hematoma, GCS, Outcome, Time
in
Acta Neurochirurgica
volume
160
issue
9
pages
7 pages
publisher
Springer
external identifiers
  • scopus:85050615670
ISSN
0001-6268
DOI
10.1007/s00701-018-3620-y
language
English
LU publication?
yes
id
4aeedee5-2fb4-4b27-97cb-c7098cb6e536
date added to LUP
2018-09-26 13:38:30
date last changed
2019-03-08 02:27:35
@article{4aeedee5-2fb4-4b27-97cb-c7098cb6e536,
  abstract     = {<p>Background: Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions. Patients diagnosed with CSDH’s are often planned for subacute surgery. This means that time from diagnostic CT scan until actual surgery might often be prolonged. There are no previous studies that highlight the effect of delayed intervention in this population. Method: Patients that underwent surgical evacuation for a CSDH at Skåne University Hospital between 1 January 2015 and 31 December 2016 were included in this retrospective cohort study (n = 179). The primary aim was to determine if time from initial diagnosis by head-CT until surgical evacuation had a significant effect on outcome. The following was assessed by mortality, re-operation, number of days spent in hospital, discharge to home/institution, and functional outcome assessed by GOS. Secondary aims were to evaluate the effect of NOAC, vitamin K antagonists, and antiplatelet drugs on time from CT to surgery and re-operation frequency. Results: Mean time from diagnostic CT scan until surgery was 76 h. No significant relationship was found between time from CT to surgical evacuation and number of days spent in hospital, discharge to own home/institution, 1-year mortality, or outcome assessed by GOS at discharge from hospital. The clear majority (95.5%) of the patients were GCS ≥ 13 pre-operatively. No correlation could be seen between use of NOAC, vitamin K antagonists, or antiplatelet drugs regarding the risk for reoperation within 6 months, and no correlation between the use of these agents and time from CT to surgery. The 30-day mortality was too low to draw any statistically significant conclusions (n = 4). Conclusion: In this retrospective cohort study, we could conclude that a delay from initial diagnosis confirming a CSDH to surgical evacuation had no negative effect on outcome when surgery was performed within the time frames and on patients with pre-operatively favorable GCS scores (≥ 13) outlined in our study.</p>},
  author       = {Zolfaghari, Shaian and Ståhl, Nils and Nittby Redebrandt, Henrietta},
  issn         = {0001-6268},
  keyword      = {Chronic subdural hematoma,GCS,Outcome,Time},
  language     = {eng},
  month        = {09},
  number       = {9},
  pages        = {1703--1709},
  publisher    = {Springer},
  series       = {Acta Neurochirurgica},
  title        = {Does time from diagnostic CT until surgical evacuation affect outcome in patients with chronic subdural hematoma?},
  url          = {http://dx.doi.org/10.1007/s00701-018-3620-y},
  volume       = {160},
  year         = {2018},
}