Neurology News

Subdural Hematoma Surgery: How Often is Retreatment Required for Patients?

Among patients who undergo subdural hematoma surgery, most retreatments occur within 3 months of initial treatment, according to study findings published in the journal Stroke: Vascular and Interventional Neurology

With an increasing aging population, the frequency of subdural hematoma-related hospitalizations is anticipated to increase in the US. Subdural hematoma is typically treated with surgical evacuation procedures, including burr-hole or craniotomy; however, these treatments have high recurrence and reoperation rates, leading to further complications.

Researchers conducted a cohort study to evaluate the 6-month retreatment rate in patients with subdural hematoma who underwent burr-hole or craniotomy.

The researchers collected patient data from the Nationwide Readmissions Database from 2016 to 2019. The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes were used to define subdural hematoma.

These data have implications for management and follow-up of SDH in clinical practice and additionally suggest rigorous randomized trials are necessary before routine incorporation of newer adjuncts …

Adult patients diagnosed with subdural hematoma who underwent burr-hole or craniotomy were included in the study. One main exclusion criterion was a history of middle meningeal artery (MMA) embolization during the initial admission.

Retreatment was defined as repeated surgical evacuation during the initial admission or any readmission.  

A total of 30,838 participants with subdural hematoma were identified from the database, with 15,806 (mean age, 69.4; 69.9% men) patients who underwent craniotomy and 15,032 (mean age, 72.2; 70.8% men) patients who underwent burr-hole. There was a significant difference in age distribution between these surgical methods (P <.001).

Within the 6-month follow-up period, 7.5% (95% CI, 7.2%-7.8%) of participants required retreatment. Of these patients, those in the burr-hole group had a higher retreatment rate (8.4%; 95% CI, 8.0%-8.9%) compared to those in the craniotomy group (6.6%; 95% CI, 6.2%-7.0%; P <.001). This trend remained consistent across the age groups of 65 to 79 and 80 and older, but not for individuals aged younger than 65.

A total of 75.4% of retreatments occurred within 30 days after initial treatment and 96.9% occurred within 90 days. Throughout the study period, retreatment rates were consistent across both surgical evacuation methods.

Exploratory endpoints identified some patient factors that decreased the likelihood of undergoing retreatment, including female sex, age 80 and older, and private or other health insurance.

“These data have implications for management and follow-up of SDH [subdural hematoma] in clinical practice and additionally suggest rigorous randomized trials are necessary before routine incorporation of newer adjuncts such as MMA embolization aimed at reducing SDH recurrence and/or retreatment,” the researchers noted.

Study limitations included a lack of patient information on death after discharge, the potential for ICD-10-CM codes not to accurately reflect acute or chronic subdural hematoma, and an inability to distinguish between initial and unilateral subdural hematoma retreatment.

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