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Standardized assessment of outcome and complications in chronic subdural hematoma: results from a large case series


Bucher, Bernadette. Standardized assessment of outcome and complications in chronic subdural hematoma: results from a large case series. 2020, University of Zurich, Faculty of Medicine.

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.

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.

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Additional indexing

Item Type:Dissertation (monographical)
Referees:Regli Luca
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Neurosurgery
UZH Dissertations
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:1 January 2020
Deposited On:27 Jan 2021 13:46
Last Modified:18 Mar 2022 09:52
Number of Pages:15
OA Status:Closed
Related URLs:https://link.springer.com/article/10.1007%2Fs00701-019-03884-7

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