Hallan David R, Freedman Zachary, Rizk Elias
Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA.
Cureus. 2022 Apr 10;14(4):e24002. doi: 10.7759/cureus.24002. eCollection 2022 Apr.
Chronic subdural hematoma (cSDH) has a number of risk factors for recurrence, and some studies suggest obesity is one of them. Yet obesity has been shown to have a positive survival benefit in many diseases such as ischemic stroke, chronic obstructive pulmonary disease, percutaneous coronary intervention, and mechanical thrombectomy. Therefore, we sought to determine if obesity provided a mortality benefit in patients with cSDH undergoing burr hole drainage or craniotomy.
We performed a retrospective database analysis using a multi-institutional (TriNetX) database looking at obese versus non-obese patients with cSDH undergoing surgical drainage. Our primary endpoint was mortality. Secondary endpoints included seizure, pulmonary embolism (PE), myocardial infarction (MI), cerebral infarction, deep vein thrombosis (DVT), tracheostomy, and percutaneous endoscopic gastrostomy (PEG). These were looked at to obtain a better idea of prognosis. Cohorts were propensity score-matched for confounders, using the greedy-nearest neighbor algorithm with a caliper of 0.1 pooled standard deviations. Kaplan-Meier survival curves were also developed, and hazard ratios were calculated. Chi-square analysis was performed on categorical variables.
A total of 1,849 patients were identified as obese with a drainage procedure, while 12,371 were identified as non-obese. Some 1,746 patients remained in each group after propensity score matching. Thirty-day survival rates were 88.08% in the obese vs. 83.82% in the non-obese cohorts, 90-day survival 85.15% vs. 79.35%, 365-day survival at 80.89% vs. 71.90%, and five-year survival at 64.75% vs. 54.84% (p < 0.0001). The risk difference was -8.02% (95% confidence interval, Cl -11.02, -5.021%); relative risk, RR 0.757, 95% Cl (0.67, 0.841); odds ratio, OR 0.676 (0.583, 0.783); p < 0.0001). Seizures, ventilator dependence, MI, cerebral infarction, tracheostomy, and PEG rates were all non-significant. Obese patients had a higher rate of PE (7.90% vs. 4.47%, p < 0.0001) and DVTs (12.37% vs. 10.02%, p = 0.0278).
Obesity in patients with cSDH undergoing surgical evacuation is associated with decreased mortality but higher rates of DVT and PE.
慢性硬膜下血肿（cSDH）有多种复发风险因素，一些研究表明肥胖是其中之一。然而，肥胖已被证明在许多疾病中具有积极的生存益处，如缺血性中风、慢性阻塞性肺疾病、经皮冠状动脉介入治疗和机械取栓术。因此，我们试图确定肥胖是否对接受钻孔引流或开颅手术的cSDH患者的死亡率有改善作用。
我们使用多机构（TriNetX）数据库进行了一项回顾性数据库分析，研究接受手术引流的肥胖与非肥胖cSDH患者。我们的主要终点是死亡率。次要终点包括癫痫发作、肺栓塞（PE）、心肌梗死（MI）、脑梗死、深静脉血栓形成（DVT）、气管切开术和经皮内镜下胃造口术（PEG）。观察这些指标以更好地了解预后情况。使用卡尺为0.1合并标准差的贪婪最近邻算法对队列进行倾向得分匹配以消除混杂因素。还绘制了Kaplan-Meier生存曲线，并计算了风险比。对分类变量进行卡方分析。
共有1849例接受引流手术的患者被确定为肥胖，12371例为非肥胖。倾向得分匹配后，每组约有1746例患者。肥胖组30天生存率为88.08%，非肥胖组为83.82%；90天生存率分别为85.15%和79.35%；365天生存率分别为80.89%和71.90%；五年生存率分别为64.75%和54.84%（p<0.0001）。风险差异为-8.02%（95%置信区间，Cl -11.02，-5.021%）；相对风险，RR 0.757，95%Cl（0.67，0.841）；优势比，OR 0.676（0.583，0.783）；p<0.0001）。癫痫发作、呼吸机依赖、MI、脑梗死、气管切开术和PEG发生率均无统计学意义。肥胖患者的PE发生率较高（7.90%对4.47%，p<0.0001），DVT发生率也较高（12.37%对10.02%，p = 0.0278）。
接受手术清除血肿的cSDH患者肥胖与死亡率降低相关，但DVT和PE发生率较高。
