BMJ Surgery, Interventions, & Health Technologies (Jul 2019)
Time to surgery following chronic subdural hematoma: post hoc analysis of a prospective cohort study
- Simon Bond,
- Thomas Santarius,
- D Bulters,
- A Borg,
- P Grover,
- K Owusu-Agyemang,
- AI Ahmed,
- L Thorne,
- C Pringle,
- WP Gray,
- P Mitchell,
- M Zaben,
- AAB Jamjoom,
- S Thomson,
- J Martin,
- S Smith,
- Angelos G Kolias,
- Paul M Brennan,
- Peter J Hutchinson,
- M Wilson,
- Sara Venturini,
- Daniel M Fountain,
- Laurence J Glancz,
- Laurent J Livermore,
- Ian C Coulter,
- Basil Matta,
- FT Afshari,
- S Alli,
- R Al-Mahfoudh,
- J Bal,
- A Belli,
- N Carleton-Bland,
- A Chari,
- D Coope,
- CJ Cowie,
- G Critchley,
- S Dambatta,
- D D’Aquino,
- B Dhamija,
- G Dobson,
- MD Fam,
- L Glancz,
- BA Gregson,
- J Halliday,
- A Hamdan,
- CS Hill,
- A Joannides,
- TL Jones,
- SM Joshi,
- A Kailaya-Vasan,
- V Karavasili,
- SA Khan,
- AT King,
- A Kuenzel,
- LJ Livermore,
- W Lo,
- H Marcus,
- S Matloob,
- D Mowle,
- H Narayanamurthy,
- RJ Nelson,
- D Ngoga,
- I Noorani,
- G O’Reilly,
- H Othman,
- KS Manjunath Prasad,
- P Plaha,
- J Pollock,
- MTC Poon,
- KS Prasad,
- R Price,
- A Ray,
- J Reaper,
- W Scotton,
- J Shapey,
- N Simms,
- P Statham,
- L Steele,
- J St George,
- MG Stovell,
- A Tarnaris,
- M Teo,
- M Vintu,
- P Whitfield,
- M Wilby,
- J Woodfield
Affiliations
- Simon Bond
- 5Cambridge Clinical Trials Unit, Cambridge, UK
- Thomas Santarius
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke`s Hospital, Cambridge, UK
- D Bulters
- A Borg
- 1Rheumatology, Mater Dei Hospital
- P Grover
- K Owusu-Agyemang
- AI Ahmed
- L Thorne
- C Pringle
- WP Gray
- P Mitchell
- M Zaben
- AAB Jamjoom
- S Thomson
- J Martin
- S Smith
- Angelos G Kolias
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Paul M Brennan
- Translational Neurosurgery, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
- Peter J Hutchinson
- Clinical Neurosciences, University of Cambridge, Cambridge, UK
- M Wilson
- Sara Venturini
- Department of Neurosurgery, Aberdeen Royal Infirmary, Aberdeen, UK
- Daniel M Fountain
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge & Addenbrooke`s Hospital, Cambridge, UK
- Laurence J Glancz
- Department of Neurosurgery, Queens Medical Centre, Manchester, UK
- Laurent J Livermore
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK
- Ian C Coulter
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
- Basil Matta
- Department of Anaesthesia, Addenbrooke`s Hospital, Cambridge, Cambridgeshire, UK
- FT Afshari
- S Alli
- R Al-Mahfoudh
- J Bal
- A Belli
- N Carleton-Bland
- A Chari
- D Coope
- CJ Cowie
- G Critchley
- S Dambatta
- D D’Aquino
- B Dhamija
- G Dobson
- MD Fam
- L Glancz
- BA Gregson
- J Halliday
- A Hamdan
- CS Hill
- A Joannides
- TL Jones
- SM Joshi
- A Kailaya-Vasan
- V Karavasili
- SA Khan
- AT King
- A Kuenzel
- LJ Livermore
- W Lo
- H Marcus
- S Matloob
- D Mowle
- H Narayanamurthy
- RJ Nelson
- D Ngoga
- I Noorani
- G O’Reilly
- H Othman
- KS Manjunath Prasad
- P Plaha
- J Pollock
- 1University of the West of England, Bristol
- MTC Poon
- KS Prasad
- R Price
- A Ray
- 7Department of Rheumatology, Radiant Medical Centre, Kolkata
- J Reaper
- W Scotton
- J Shapey
- N Simms
- P Statham
- L Steele
- J St George
- MG Stovell
- A Tarnaris
- M Teo
- M Vintu
- P Whitfield
- M Wilby
- J Woodfield
- DOI
- https://doi.org/10.1136/bmjsit-2019-000012
- Journal volume & issue
-
Vol. 1,
no. 1
Abstract
Background Chronic subdural hematoma (CSDH) is a common neurological condition; surgical evacuation is the mainstay of treatment for symptomatic patients. No clear evidence exists regarding the impact of timing of surgery on outcomes. We investigated factors influencing time to surgery and its impact on outcomes of interest.Methods Patients with CSDH who underwent burr-hole craniostomy were included. This is a subset of data from a prospective observational study conducted in the UK. Logistic mixed modelling was performed to examine the factors influencing time to surgery. The impact of time to surgery on discharge modified Rankin Scale (mRS), complications, recurrence, length of stay and survival was investigated with multivariable logistic regression analysis.Results 656 patients were included. Time to surgery ranged from 0 to 44 days (median 1, IQR 1–3). Older age, more favorable mRS on admission, high preoperative Glasgow Coma Scale score, use of antiplatelet medications, comorbidities and bilateral hematomas were associated with increased time to surgery. Time to surgery showed a significant positive association with length of stay; it was not associated with outcome, complication rate, reoperation rate, or survival on multivariable analysis. There was a trend for patients with time to surgery of ≥7 days to have lower odds of favorable outcome at discharge (p=0.061).Conclusions This study provides evidence that time to surgery does not substantially impact on outcomes following CSDH. However, increasing time to surgery is associated with increasing length of stay. These results should not encourage delaying operations for patients when they are clinically indicated.
