Outcomes following surgery in subgroups of comatose and very elderly patients with chronic subdural hematoma

Edward Christopher; Michael T.C. Poon; Laurence J. Glancz; Peter J. Hutchinson; Angelos G. Kolias; Paul M. Brennan; F. T. Afshari; A. I. Ahmed; S. Alli; R. Al-Mahfoudh; J. Bal; A. Belli; A. Borg; D. Bulters; N. Carleton-Bland; A. Chari; D. Coope; I. C. Coulter; C. J. Cowie; G. Critchley; S. Dambatta; D. D’Aquino; B. Dhamija; M. D. Fam; W. P. Gray; B. A. Gregson; P. J. Grover; J. Halliday; A. Hamdan; C. S. Hill; A. A.B. Jamjoom; A. J. Joannides; T. L. Jones; S. M. Joshi; A. Kailaya-Vasan; V. Karavasili; S. A. Khan; A. T. King; A. Kuenzel; L. J. Livermore; W. Lo; H. J. Marcus; J. Martin; S. Matloob; P. Mitchell; D. Mowle; W. Scotton; A. Tarnaris; S. Thomson; L. Thorne; British Neurosurgical Trainee Research Collaborative

doi:10.1007/s10143-018-0979-4

Outcomes following surgery in subgroups of comatose and very elderly patients with chronic subdural hematoma

Edward Christopher, Michael T.C. Poon, Laurence J. Glancz, Peter J. Hutchinson, Angelos G. Kolias, Paul M. Brennan^*, F. T. Afshari, A. I. Ahmed, S. Alli, R. Al-Mahfoudh, J. Bal, A. Belli, A. Borg, D. Bulters, N. Carleton-Bland, A. Chari, D. Coope, I. C. Coulter, C. J. Cowie, G. CritchleyS. Dambatta, D. D’Aquino, B. Dhamija, M. D. Fam, W. P. Gray, B. A. Gregson, P. J. Grover, J. Halliday, A. Hamdan, C. S. Hill, A. A.B. Jamjoom, A. J. Joannides, T. L. Jones, S. M. Joshi, A. Kailaya-Vasan, V. Karavasili, S. A. Khan, A. T. King, A. Kuenzel, L. J. Livermore, W. Lo, H. J. Marcus, J. Martin, S. Matloob, P. Mitchell, D. Mowle, W. Scotton, A. Tarnaris, S. Thomson, L. Thorne, British Neurosurgical Trainee Research Collaborative

^*Corresponding author for this work

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Abstract

Increasing age and lower pre-operative Glasgow coma score (GCS) are associated with worse outcome after surgery for chronic subdural haematoma (CSDH). Only few studies have quantified outcomes specific to the very elderly or comatose patients. We aim to examine surgical outcomes in these patient groups. We analysed data from a prospective multicentre cohort study, assessing the risk of recurrence, death, and unfavourable functional outcome of very elderly (≥ 90 years) patients and comatose (pre-operative GCS ≤ 8) patients following surgical treatment of CSDH. Seven hundred eighty-five patients were included in the study. Thirty-two (4.1%) patients had pre-operative GCS ≤ 8 and 70 (8.9%) patients were aged ≥ 90 years. A higher proportion of comatose patients had an unfavourable functional outcome (38.7 vs 21.7%; p = 0.03), although similar proportion of comatose (64.5%) and non-comatose patients (61.8%) functionally improved after surgery (p = 0.96). Compared to patients aged < 90 years, a higher proportion of patients aged ≥ 90 years had unfavourable functional outcome (41.2 vs 20.5%; p < 0.01), although approximately half had functional improvement following surgery. Mortality risk was higher in both comatose (6.3 vs 1.9%; p = 0.05) and very elderly (8.8 vs 1.1%; p < 0.01) groups. There was a trend towards a higher recurrence risk in the comatose group (19.4 vs 9.5%; p = 0.07). Surgery can still provide considerable benefit to very elderly and comatose patients despite their higher risk of morbidity and mortality. Further research would be needed to better identify those most likely to benefit from surgery in these groups.

Original language	English
Pages (from-to)	1-5
Number of pages	5
Journal	Neurosurgical Review
Early online date	21 Apr 2018
DOIs	https://doi.org/10.1007/s10143-018-0979-4
Publication status	E-pub ahead of print - 21 Apr 2018

Keywords

Chronic subdural hematoma
Comatose
Outcome
Surgery
Very elderly

ASJC Scopus subject areas

Surgery
Clinical Neurology

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Christopher_et_al_Outcomes_following_surgery_Neurosurgical_Review_2018
Published in Neurosurgical Review on 21/04/2018 DOI: 10.1007/s10143-018-0979-4
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Christopher, E., Poon, M. T. C., Glancz, L. J., Hutchinson, P. J., Kolias, A. G., Brennan, P. M., Afshari, F. T., Ahmed, A. I., Alli, S., Al-Mahfoudh, R., Bal, J., Belli, A., Borg, A., Bulters, D., Carleton-Bland, N., Chari, A., Coope, D., Coulter, I. C., Cowie, C. J., ... British Neurosurgical Trainee Research Collaborative (2018). Outcomes following surgery in subgroups of comatose and very elderly patients with chronic subdural hematoma. Neurosurgical Review, 1-5. Advance online publication. https://doi.org/10.1007/s10143-018-0979-4

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title = "Outcomes following surgery in subgroups of comatose and very elderly patients with chronic subdural hematoma",

abstract = "Increasing age and lower pre-operative Glasgow coma score (GCS) are associated with worse outcome after surgery for chronic subdural haematoma (CSDH). Only few studies have quantified outcomes specific to the very elderly or comatose patients. We aim to examine surgical outcomes in these patient groups. We analysed data from a prospective multicentre cohort study, assessing the risk of recurrence, death, and unfavourable functional outcome of very elderly (≥ 90 years) patients and comatose (pre-operative GCS ≤ 8) patients following surgical treatment of CSDH. Seven hundred eighty-five patients were included in the study. Thirty-two (4.1%) patients had pre-operative GCS ≤ 8 and 70 (8.9%) patients were aged ≥ 90 years. A higher proportion of comatose patients had an unfavourable functional outcome (38.7 vs 21.7%; p = 0.03), although similar proportion of comatose (64.5%) and non-comatose patients (61.8%) functionally improved after surgery (p = 0.96). Compared to patients aged < 90 years, a higher proportion of patients aged ≥ 90 years had unfavourable functional outcome (41.2 vs 20.5%; p < 0.01), although approximately half had functional improvement following surgery. Mortality risk was higher in both comatose (6.3 vs 1.9%; p = 0.05) and very elderly (8.8 vs 1.1%; p < 0.01) groups. There was a trend towards a higher recurrence risk in the comatose group (19.4 vs 9.5%; p = 0.07). Surgery can still provide considerable benefit to very elderly and comatose patients despite their higher risk of morbidity and mortality. Further research would be needed to better identify those most likely to benefit from surgery in these groups.",

keywords = "Chronic subdural hematoma, Comatose, Outcome, Surgery, Very elderly",

author = "Edward Christopher and Poon, {Michael T.C.} and Glancz, {Laurence J.} and Hutchinson, {Peter J.} and Kolias, {Angelos G.} and Brennan, {Paul M.} and Afshari, {F. T.} and Ahmed, {A. I.} and S. Alli and R. Al-Mahfoudh and J. Bal and A. Belli and A. Borg and D. Bulters and N. Carleton-Bland and A. Chari and D. Coope and Coulter, {I. C.} and Cowie, {C. J.} and G. Critchley and S. Dambatta and D. D{\textquoteright}Aquino and B. Dhamija and Fam, {M. D.} and Gray, {W. P.} and Gregson, {B. A.} and Grover, {P. J.} and J. Halliday and A. Hamdan and Hill, {C. S.} and Jamjoom, {A. A.B.} and Joannides, {A. J.} and Jones, {T. L.} and Joshi, {S. M.} and A. Kailaya-Vasan and V. Karavasili and Khan, {S. A.} and King, {A. T.} and A. Kuenzel and Livermore, {L. J.} and W. Lo and Marcus, {H. J.} and J. Martin and S. Matloob and P. Mitchell and D. Mowle and W. Scotton and A. Tarnaris and S. Thomson and L. Thorne and {British Neurosurgical Trainee Research Collaborative}",

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doi = "10.1007/s10143-018-0979-4",

language = "English",

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journal = "Neurosurgical Review",

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Christopher, E, Poon, MTC, Glancz, LJ, Hutchinson, PJ, Kolias, AG, Brennan, PM, Afshari, FT, Ahmed, AI, Alli, S, Al-Mahfoudh, R, Bal, J, Belli, A, Borg, A, Bulters, D, Carleton-Bland, N, Chari, A, Coope, D, Coulter, IC, Cowie, CJ, Critchley, G, Dambatta, S, D’Aquino, D, Dhamija, B, Fam, MD, Gray, WP, Gregson, BA, Grover, PJ, Halliday, J, Hamdan, A, Hill, CS, Jamjoom, AAB, Joannides, AJ, Jones, TL, Joshi, SM, Kailaya-Vasan, A, Karavasili, V, Khan, SA, King, AT, Kuenzel, A, Livermore, LJ, Lo, W, Marcus, HJ, Martin, J, Matloob, S, Mitchell, P, Mowle, D, Scotton, W, Tarnaris, A, Thomson, S, Thorne, L & British Neurosurgical Trainee Research Collaborative 2018, 'Outcomes following surgery in subgroups of comatose and very elderly patients with chronic subdural hematoma', Neurosurgical Review, pp. 1-5. https://doi.org/10.1007/s10143-018-0979-4

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T1 - Outcomes following surgery in subgroups of comatose and very elderly patients with chronic subdural hematoma

AU - Christopher, Edward

AU - Poon, Michael T.C.

AU - Glancz, Laurence J.

AU - Hutchinson, Peter J.

AU - Kolias, Angelos G.

AU - Brennan, Paul M.

AU - Afshari, F. T.

AU - Ahmed, A. I.

AU - Alli, S.

AU - Al-Mahfoudh, R.

AU - Bal, J.

AU - Belli, A.

AU - Borg, A.

AU - Bulters, D.

AU - Carleton-Bland, N.

AU - Chari, A.

AU - Coope, D.

AU - Coulter, I. C.

AU - Cowie, C. J.

AU - Critchley, G.

AU - Dambatta, S.

AU - D’Aquino, D.

AU - Dhamija, B.

AU - Fam, M. D.

AU - Gray, W. P.

AU - Gregson, B. A.

AU - Grover, P. J.

AU - Halliday, J.

AU - Hamdan, A.

AU - Hill, C. S.

AU - Jamjoom, A. A.B.

AU - Joannides, A. J.

AU - Jones, T. L.

AU - Joshi, S. M.

AU - Kailaya-Vasan, A.

AU - Karavasili, V.

AU - Khan, S. A.

AU - King, A. T.

AU - Kuenzel, A.

AU - Livermore, L. J.

AU - Lo, W.

AU - Marcus, H. J.

AU - Martin, J.

AU - Matloob, S.

AU - Mitchell, P.

AU - Mowle, D.

AU - Scotton, W.

AU - Tarnaris, A.

AU - Thomson, S.

AU - Thorne, L.

AU - British Neurosurgical Trainee Research Collaborative

PY - 2018/4/21

Y1 - 2018/4/21

N2 - Increasing age and lower pre-operative Glasgow coma score (GCS) are associated with worse outcome after surgery for chronic subdural haematoma (CSDH). Only few studies have quantified outcomes specific to the very elderly or comatose patients. We aim to examine surgical outcomes in these patient groups. We analysed data from a prospective multicentre cohort study, assessing the risk of recurrence, death, and unfavourable functional outcome of very elderly (≥ 90 years) patients and comatose (pre-operative GCS ≤ 8) patients following surgical treatment of CSDH. Seven hundred eighty-five patients were included in the study. Thirty-two (4.1%) patients had pre-operative GCS ≤ 8 and 70 (8.9%) patients were aged ≥ 90 years. A higher proportion of comatose patients had an unfavourable functional outcome (38.7 vs 21.7%; p = 0.03), although similar proportion of comatose (64.5%) and non-comatose patients (61.8%) functionally improved after surgery (p = 0.96). Compared to patients aged < 90 years, a higher proportion of patients aged ≥ 90 years had unfavourable functional outcome (41.2 vs 20.5%; p < 0.01), although approximately half had functional improvement following surgery. Mortality risk was higher in both comatose (6.3 vs 1.9%; p = 0.05) and very elderly (8.8 vs 1.1%; p < 0.01) groups. There was a trend towards a higher recurrence risk in the comatose group (19.4 vs 9.5%; p = 0.07). Surgery can still provide considerable benefit to very elderly and comatose patients despite their higher risk of morbidity and mortality. Further research would be needed to better identify those most likely to benefit from surgery in these groups.

AB - Increasing age and lower pre-operative Glasgow coma score (GCS) are associated with worse outcome after surgery for chronic subdural haematoma (CSDH). Only few studies have quantified outcomes specific to the very elderly or comatose patients. We aim to examine surgical outcomes in these patient groups. We analysed data from a prospective multicentre cohort study, assessing the risk of recurrence, death, and unfavourable functional outcome of very elderly (≥ 90 years) patients and comatose (pre-operative GCS ≤ 8) patients following surgical treatment of CSDH. Seven hundred eighty-five patients were included in the study. Thirty-two (4.1%) patients had pre-operative GCS ≤ 8 and 70 (8.9%) patients were aged ≥ 90 years. A higher proportion of comatose patients had an unfavourable functional outcome (38.7 vs 21.7%; p = 0.03), although similar proportion of comatose (64.5%) and non-comatose patients (61.8%) functionally improved after surgery (p = 0.96). Compared to patients aged < 90 years, a higher proportion of patients aged ≥ 90 years had unfavourable functional outcome (41.2 vs 20.5%; p < 0.01), although approximately half had functional improvement following surgery. Mortality risk was higher in both comatose (6.3 vs 1.9%; p = 0.05) and very elderly (8.8 vs 1.1%; p < 0.01) groups. There was a trend towards a higher recurrence risk in the comatose group (19.4 vs 9.5%; p = 0.07). Surgery can still provide considerable benefit to very elderly and comatose patients despite their higher risk of morbidity and mortality. Further research would be needed to better identify those most likely to benefit from surgery in these groups.

KW - Chronic subdural hematoma

KW - Comatose

KW - Outcome

KW - Surgery

KW - Very elderly

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JO - Neurosurgical Review

JF - Neurosurgical Review

ER -

Outcomes following surgery in subgroups of comatose and very elderly patients with chronic subdural hematoma

Abstract

Keywords

ASJC Scopus subject areas

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