Bernadette Bucher1, Nicolai Maldaner2, Luca Regli2, Johannes Sarnthein2, Carlo Serra2. 1. Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland. bernadette.bucher@gmx.net. 2. Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
Abstract
INTRODUCTION: Chronic subdural hematomas (cSDH) are commonly deemed to have a benign prognosis. However, detailed and standardized data describing outcome and complications in a large prospective patient cohort is lacking. METHODS: Retrospective analysis of prospectively collected data in our institutional patient registry on consecutive patients undergoing surgery for cSDH from 2013 to 2017. Complications were assessed according to the Clavien-Dindo grading system (CDG). The outcome was measured with respect to two endpoints: occurrence of a complication with CDG 3-5 and lack of improvement in Karnofsky Performance Status (KPS) at the last follow-up. RESULTS: Out of 435 operations, 166 (38.3%) presented a complication until 3 months postoperative (CDG 1, 23 (5.3%); CDG 2, 62 (14.3%); CDG 3a, 7 (1.6%); CDG 3b, 64 (14.7%); CDG 4a, 2 (0.5%); and CDG 5, 8 (1.8%)). Higher CDG correlated with a lower KPS (rs = - 0.27, p < 0.001). A lack of improvement in KPS was associated with a Charlson Comorbidity Index (CCI) > 1 and the iso- or hypodense appearance of the cSDH. CONCLUSIONS: This study provides a reliable estimate of the rate of medical and surgical complications in cSDH surgery. Complications that required a surgical intervention turned out to be rare. Recording complications in a standardized and prospective fashion can therefore serve as a basis for assessing patient outcome and quality control within the department.
INTRODUCTION:Chronic subdural hematomas (cSDH) are commonly deemed to have a benign prognosis. However, detailed and standardized data describing outcome and complications in a large prospective patient cohort is lacking. METHODS: Retrospective analysis of prospectively collected data in our institutional patient registry on consecutive patients undergoing surgery for cSDH from 2013 to 2017. Complications were assessed according to the Clavien-Dindo grading system (CDG). The outcome was measured with respect to two endpoints: occurrence of a complication with CDG 3-5 and lack of improvement in Karnofsky Performance Status (KPS) at the last follow-up. RESULTS: Out of 435 operations, 166 (38.3%) presented a complication until 3 months postoperative (CDG 1, 23 (5.3%); CDG 2, 62 (14.3%); CDG 3a, 7 (1.6%); CDG 3b, 64 (14.7%); CDG 4a, 2 (0.5%); and CDG 5, 8 (1.8%)). Higher CDG correlated with a lower KPS (rs = - 0.27, p < 0.001). A lack of improvement in KPS was associated with a Charlson Comorbidity Index (CCI) > 1 and the iso- or hypodense appearance of the cSDH. CONCLUSIONS: This study provides a reliable estimate of the rate of medical and surgical complications in cSDH surgery. Complications that required a surgical intervention turned out to be rare. Recording complications in a standardized and prospective fashion can therefore serve as a basis for assessing patient outcome and quality control within the department.
Authors: Giovanna Brandi; Vittorio Stumpo; Marco Gilone; Lazar Tosic; Johannes Sarnthein; Victor E Staartjes; Sophie Shih-Yüng Wang; Bas Van Niftrik; Luca Regli; Emanuela Keller; Carlo Serra Journal: Medicine (Baltimore) Date: 2022-07-08 Impact factor: 1.817
Authors: Andrea Di Cristofori; Paolo Remida; Mirko Patassini; Lorenzo Piergallini; Raffaella Buonanno; Raffaele Bruno; Giorgio Carrabba; Giacomo Pavesi; Corrado Iaccarino; Carlo Giorgio Giussani Journal: Surg Neurol Int Date: 2022-03-18