Department of Neurosurgery, Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands; Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands.
Department of Neurosurgery, Erasmus Medical Center, Erasmus MC Stroke Center, Rotterdam, the Netherlands.
World Neurosurg. 2022 Jun;162:e358-e368. doi: 10.1016/j.wneu.2022.03.014. Epub 2022 Mar 9.
We aimed to quantify the need for additional surgery in patients with chronic subdural hematoma (CSDH) primarily treated with dexamethasone and to identify patient characteristics associated with additional surgery.
Data were retrospectively collected from 283 patients with CSDH, primarily treated with dexamethasone, in 3 hospitals from 2008 to 2018. Primary outcome was the need for additional surgery. The association between baseline characteristics and additional surgery was analyzed with univariable and multivariable logistic regression analysis and presented as adjusted odds ratios (aOR).
In total, 283 patients with CSDH were included: 146 patients (51.6%) received 1 dexamethasone course (DXM group), 30 patients (10.6%) received 2 dexamethasone courses (DXM-DXM group), and 107 patients (37.8%) received additional surgery (DXM-SURG group). Patients who underwent surgery more often had a Markwalder Grading Scale of 2 (as compared with 1, aOR 2.05; 95% confidence interval [CI] 0.90-4.65), used statins (aOR 2.09; 95% CI 1.01-4.33), had a larger midline shift (aOR 1.10 per mm; 95% CI 1.01-1.21) and had larger hematoma thickness (aOR 1.16 per mm; 95% CI 1.09-1.23), had a bilateral hematoma (aOR 1.85; 95% CI 0.90-3.79), and had a separated hematoma (as compared with homogeneous, aOR 1.77; 95% CI 0.72-4.38). Antithrombotics (aOR 0.45; 95% CI 0.21-0.95) and trabecular hematoma (as compared with homogeneous, aOR 0.31; 95% CI 0.12-0.77) were associated with a lower likelihood of surgery.
More than one-third of patients with CSDH primarily treated with dexamethasone received additional surgery. These patients were more severely affected amongst others with larger hematomas.
我们旨在量化主要接受地塞米松治疗的慢性硬脑膜下血肿（CSDH）患者的额外手术需求，并确定与额外手术相关的患者特征。
我们回顾性地收集了 2008 年至 2018 年期间，3 家医院 283 例主要接受地塞米松治疗的 CSDH 患者的数据。主要结局为需要进行额外手术。使用单变量和多变量逻辑回归分析来分析基线特征与额外手术之间的关系，并以调整后的优势比（aOR）表示。
共纳入 283 例 CSDH 患者：146 例（51.6%）接受 1 个地塞米松疗程（DXM 组），30 例（10.6%）接受 2 个地塞米松疗程（DXM-DXM 组），107 例（37.8%）接受了手术（DXM-SURG 组）。接受手术的患者更常出现 Markwalder 分级 2（与分级 1 相比，aOR 2.05；95%CI 0.90-4.65），使用他汀类药物（aOR 2.09；95%CI 1.01-4.33），中线移位更大（aOR 每毫米 1.10；95%CI 1.01-1.21），血肿厚度更大（aOR 每毫米 1.16；95%CI 1.09-1.23），双侧血肿（aOR 1.85；95%CI 0.90-3.79），以及分隔血肿（与均质血肿相比，aOR 1.77；95%CI 0.72-4.38）。抗血栓药物（aOR 0.45；95%CI 0.21-0.95）和小梁血肿（与均质血肿相比，aOR 0.31；95%CI 0.12-0.77）与手术可能性降低相关。
超过三分之一的主要接受地塞米松治疗的 CSDH 患者接受了额外的手术。这些患者的病情更严重，血肿更大。
