Sase Taigen, Furuya Yu, Tanaka Yuichiro
Department of Neurosurgery, St. Marianna University School of Medicine.
No Shinkei Geka. 2020 Dec;48(12):1115-1120. doi: 10.11477/mf.1436204334.
Chronic subdural hematoma(CSDH)is a common condition encountered by neurosurgeons. Owing to increasing life expectancy and rapid population aging, the age at disease onset is delayed, which negatively affects hospital discharge arrangements. This retrospective study investigated patients aged ≥90 years who underwent surgery for CSDH.
The study included 53 patients diagnosed with CSDH(63 sides)for the first time, who underwent surgery at our hospital between April 2018 and March 2019. The mean age was 78.7 years, and the study included 40 men. A subdural drain was placed after burr hole surgery performed for hematoma evacuation and lavage. The basic protocol included 8-day hospitalization comprising surgery on the day of admission, rehabilitation initiated the day after surgery, and suture removal 7 days after surgery, followed by hospital discharge. The 'elderly' group(Group E)included patients aged ≥90 years, and the 'others' group(Group O)included patients aged <90 years. This study focused on hospital discharge arrangements.
The mean length of hospitalization was 7.6 days in 10 patients(19%)in Group E. The rate of intervention by a discharge support nurse or medical social worker(Medical Consultation Team)was 100% in Group E and 65% in Group O. All patients were discharged to planned living arrangements with the assistance of the Medical Consultation Team and rehabilitation intervention.
Among elderly patients, difficulties with hospital discharge arrangements could be attributed to exacerbation of dementia symptoms after hospitalization and manifestations of disuse syndrome and complications. Surgical treatment can be offered to patients with CSDH regardless of age(even to those aged >90 years)and facilitates smooth discharge with multidisciplinary intervention.
慢性硬膜下血肿（CSDH）是神经外科医生常遇到的一种病症。由于预期寿命延长和人口快速老龄化，发病年龄推迟，这对出院安排产生了负面影响。本回顾性研究调查了年龄≥90岁接受CSDH手术的患者。
该研究纳入了53例首次诊断为CSDH（63侧）的患者，他们于2018年4月至2019年3月在我院接受手术。平均年龄为78.7岁，其中男性40例。在进行血肿清除和冲洗的钻孔手术后放置硬膜下引流管。基本方案包括住院8天，入院当天手术，术后第1天开始康复治疗，术后7天拆线，随后出院。“老年”组（E组）包括年龄≥90岁的患者，“其他”组（O组）包括年龄<90岁的患者。本研究重点关注出院安排。
E组10例（19%）患者的平均住院时间为7.6天。出院支持护士或医务社会工作者（医疗咨询团队）的干预率在E组为100%，在O组为65%。所有患者在医疗咨询团队和康复干预的协助下出院至计划的生活安排。
在老年患者中，出院安排困难可能归因于住院后痴呆症状加重以及废用综合征和并发症的表现。对于CSDH患者，无论年龄大小（甚至>90岁的患者）均可进行手术治疗，并通过多学科干预促进顺利出院。
