Time to surgery following chronic subdural hematoma: post hoc analysis of a prospective cohort study.
cohort study
outcomes research
real world evidence
Journal
BMJ surgery, interventions, & health technologies
ISSN: 2631-4940
Titre abrégé: BMJ Surg Interv Health Technol
Pays: England
ID NLM: 101764673
Informations de publication
Date de publication:
2019
2019
Historique:
received:
07
05
2019
revised:
26
08
2019
accepted:
04
10
2019
entrez:
20
1
2022
pubmed:
16
12
2019
medline:
16
12
2019
Statut:
epublish
Résumé
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. 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. 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). 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.
Sections du résumé
BACKGROUND
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
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
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
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.
Identifiants
pubmed: 35047776
doi: 10.1136/bmjsit-2019-000012
pii: bmjsit-2019-000012
pmc: PMC8749282
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e000012Investigateurs
F T Afshari
(FT)
A I Ahmed
(AI)
S Alli
(S)
R Al-Mahfoudh
(R)
J Bal
(J)
A Belli
(A)
A Borg
(A)
D Bulters
(D)
N Carleton-Bland
(N)
A Chari
(A)
D Coope
(D)
C J Cowie
(CJ)
G Critchley
(G)
S Dambatta
(S)
D D'Aquino
(D)
B Dhamija
(B)
G Dobson
(G)
M D Fam
(MD)
L Glancz
(L)
W P Gray
(WP)
B A Gregson
(BA)
P Grover
(P)
J Halliday
(J)
A Hamdan
(A)
C S Hill
(CS)
Aab Jamjoom
(A)
A Joannides
(A)
T L Jones
(TL)
S M Joshi
(SM)
A Kailaya-Vasan
(A)
V Karavasili
(V)
S A Khan
(SA)
A T King
(AT)
A Kuenzel
(A)
L J Livermore
(LJ)
W Lo
(W)
H Marcus
(H)
J Martin
(J)
S Matloob
(S)
P Mitchell
(P)
D Mowle
(D)
H Narayanamurthy
(H)
R J Nelson
(RJ)
D Ngoga
(D)
I Noorani
(I)
G O'Reilly
(G)
H Othman
(H)
K Owusu-Agyemang
(K)
K S Manjunath Prasad
(KS)
P Plaha
(P)
J Pollock
(J)
Mtc Poon
(M)
K S Prasad
(KS)
R Price
(R)
C Pringle
(C)
A Ray
(A)
J Reaper
(J)
W Scotton
(W)
J Shapey
(J)
N Simms
(N)
S Smith
(S)
P Statham
(P)
L Steele
(L)
J St George
(J)
M G Stovell
(MG)
A Tarnaris
(A)
M Teo
(M)
S Thomson
(S)
L Thorne
(L)
M Vintu
(M)
P Whitfield
(P)
M Wilson
(M)
M Wilby
(M)
J Woodfield
(J)
M Zaben
(M)
Informations de copyright
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
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