Bounajem Michael T, Peitz Geoffrey, Fernandez Roman, Wang Zhu, McGinity Michael, Grandhi Ramesh
Neurosurgery, University of Utah, Salt Lake City, USA.
Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio, USA.
Cureus. 2022 May 6;14(5):e24779. doi: 10.7759/cureus.24779. eCollection 2022 May.
Background Preoperative identification of clinical, radiographic, and surgery-specific factors associated with nonacute subdural hematomas (SDHs) may enable clinicians to optimize the efficacy of the initial surgical intervention, improve outcomes, and decrease rates of surgical recurrence. Methods The authors identified patients aged ≥65 years who underwent surgical treatment of chronic, subacute, or mixed-density SDH at a level-1 trauma hospital over a ten-year period (2010-2019). Pre-and postoperative clinical, radiographic, and surgery-specific data were collected. Predictors of surgical recurrence as well as morbidity, mortality, and discharge disposition were analyzed. Results There were 268 nonacute SDHs treated surgically; 46 were chronic, 19 were subacute, and 203 were mixed density. Of these, 179 were treated with burr hole(s), 62 with miniature craniotomy, and 27 via a large craniotomy and removal of subdural membranes. Statin use was protective (OR 0.22; 95% CI 0.08, 0.60) against recurrence requiring reoperation. Preoperative use of antithrombotic agents was not significantly associated with increased recurrence requiring reoperation. Smaller preoperative hematoma thickness was associated with significantly lower mortality risk, whereas mixed-density hematomas, patient age, change in thickness after surgery, density, and presence of cisternal effacement were significantly associated with discharge disposition. Hematoma type was also associated with hospital and intensive care length of stay. Conclusions Our experience suggests that, in elderly patients, premorbid statin usage is associated with lower recurrence rates and preoperative antithrombotic use does not affect recurrence when appropriately reversed before surgery. Patient age, preoperative thickness, and hematoma type contribute to postoperative outcomes such as discharge disposition and length of stay.
背景 术前识别与非急性硬膜下血肿（SDH）相关的临床、影像学和手术特定因素，可能使临床医生能够优化初始手术干预的效果，改善预后，并降低手术复发率。方法 作者确定了年龄≥65岁、在一家一级创伤医院接受慢性、亚急性或混合密度SDH手术治疗的患者，时间跨度为十年（2010 - 2019年）。收集术前和术后的临床、影像学和手术特定数据。分析手术复发的预测因素以及发病率、死亡率和出院处置情况。结果 共268例非急性SDH接受了手术治疗；其中46例为慢性，19例为亚急性，203例为混合密度。其中，179例采用钻孔引流治疗，62例采用微型开颅手术，27例通过大骨瓣开颅并切除硬膜下膜治疗。使用他汀类药物对需要再次手术的复发具有保护作用（OR 0.22；95% CI 0.08，0.60）。术前使用抗血栓药物与需要再次手术的复发增加无显著相关性。术前血肿厚度较小与死亡风险显著降低相关，而混合密度血肿、患者年龄、术后厚度变化、密度以及脑池受压的存在与出院处置显著相关。血肿类型也与住院时间和重症监护时间相关。结论 我们的经验表明，在老年患者中，病前使用他汀类药物与较低的复发率相关，术前使用抗血栓药物在术前适当逆转时不影响复发。患者年龄、术前厚度和血肿类型会影响术后结局，如出院处置和住院时间。
