Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland.
Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland.
World Neurosurg. 2021 Jun;150:e337-e346. doi: 10.1016/j.wneu.2021.03.002. Epub 2021 Mar 9.
Chronic subdural hematoma is frequently seen within the elderly population and neurosurgeons are confronted with patients older than 80 years presenting with symptomatic chronic subdural hematoma. However, data on surgical outcome are scarce. The aim of this study is to analyze the mortality and outcome after burr-hole drainage in patients older than 80 years.
This is a single-center retrospective study including patients who underwent burr-hole drainage of chronic subdural hematoma between the years 2016 and 2019. The cohort was divided into 3 age groups (80-84 years; 85-89 years; >90 years). Primary outcome was 30-day and overall mortality, whereas secondary outcome measures were recurrence rates, postoperative bleeding rates, and outcome measured by the modified ranking scale. Uni- and multivariate analysis was conducted to assess for potential risk factors for mortality, recurrence and postoperative bleeding rates.
In total, 107 patients with a mean age of 85.5 ± 3.9 years were included. Mortality rate was less than 10% in each group, showing no significant difference between them (P = 0.455). No significant difference in recurrence and postoperative bleeding rates was seen (P = 0.491 and P = 0.532). Modified Ranking scale score differed significantly at release, whereas at follow-up no difference was seen. After uni- and multivariate analysis, age was not correlated with higher recurrence, postoperative bleeding, or mortality rates. Preoperative midline shift was found to be an independent risk factor for recurrence.
In patients older than 80 years undergoing burr-hole drainage for chronic subdural hematoma, age was not directly correlated with higher recurrence, postoperative bleeding, or mortality rates.
慢性硬脑膜下血肿在老年人群中较为常见，神经外科医生经常会遇到 80 岁以上因症状性慢性硬脑膜下血肿就诊的患者。然而，关于手术结果的数据却很少。本研究旨在分析 80 岁以上患者行颅骨钻孔引流术的死亡率和预后。
这是一项单中心回顾性研究，纳入了 2016 年至 2019 年期间行颅骨钻孔引流慢性硬脑膜下血肿的患者。该队列分为 3 个年龄组（80-84 岁；85-89 岁；>90 岁）。主要结局为 30 天和总体死亡率，次要结局指标为复发率、术后出血率和改良 Rankin 量表评分评估的预后。进行单因素和多因素分析以评估死亡率、复发率和术后出血率的潜在危险因素。
共纳入 107 例患者，平均年龄为 85.5 ± 3.9 岁。每组的死亡率均低于 10%，且组间差异无统计学意义（P=0.455）。复发率和术后出血率无显著差异（P=0.491 和 P=0.532）。改良 Rankin 量表评分在出院时差异显著，而在随访时无差异。单因素和多因素分析后，年龄与更高的复发、术后出血或死亡率无相关性。术前中线移位被发现是复发的独立危险因素。
对于 80 岁以上行颅骨钻孔引流术治疗慢性硬脑膜下血肿的患者，年龄与更高的复发、术后出血或死亡率无直接相关性。
