Abstract

Chronic subdural hematoma (CSDH) is an old blood collection between the cortical surface and the dura. Recurrence of CSDH after surgical evacuation occurs in up to a quarter of patients. The association between patient premorbid status and the rate of recurrence is not well known, and some previous results are contradictory. We aim to determine the impact of patient comorbidities in the risk of recurrence after surgical evacuation of CSDH. Retrospective data of a single institution’s surgically evacuated CSDH cases followed up for at least 6 months were analyzed, and univariate and multivariate analyses were performed to identify the relationships between recurrence of CSDH and factors such as age, gender, CSDH thickness, neurological impairment at admission (NIHSS score), location of the CSDH (unilateral vs bilateral), Charlson Comorbidity Index (CCI), prothrombin time (PT), hemoglobin levels, and platelet count. A total of 90 patients (71 men and 19 women), aged 41–100 years (mean age, 76.4 ± 11.2 years), were included. CSDH recurred in 17 patients (18.9%). A higher CCI correlated with higher scores in the NIHSS. In the univariate analysis, recurrence was associated with a higher CCI (2.39 vs 1.22, p = 0.002), higher NIHSS scores (6.5 vs 4, p = 0.034), and lower PT levels (9.9 vs 13.4, p = 0.007). In multivariate analysis, only PT and CCI demonstrated to be independent risk factors for CSDH recurrence after surgical evacuation (p = 0.033 and p = 0.024, respectively). Patients with more comorbidities have a higher risk of developing recurrent CSDH. CCI provides a simple way of predicting recurrence in patients with CSDH and should be incorporated into decision-making processes, when counseling patients.

中文翻译：

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合并症在慢性硬膜下血肿复发中的作用

摘要

慢性硬膜下血肿（CSDH）是皮层表面和硬脑膜之间的旧血样。外科排空后CSDH的复发发生在多达四分之一的患者中。患者病前状态与复发率之间的关联尚不清楚，并且某些先前的结果相互矛盾。我们的目的是确定CSDH手术后患者合并症对复发风险的影响。分析单个机构手术后撤离的CSDH病例至少6个月的回顾性数据，并进行单因素和多因素分析，以确定CSDH复发与年龄，性别，CSDH厚度，入院时神经功能障碍等因素之间的关系。 （NIHSS得分），CSDH的位置（单边还是双边），查尔森合并症指数（CCI），凝血酶原时间（PT），血红蛋白水平和血小板计数。包括90例患者（71例男性和19例女性），年龄41-100岁（平均年龄76.4±11.2岁）。CSDH复发17例（18.9％）。较高的CCI与NIHSS中较高的分数相关。在单变量分析中，复发与较高的CCI相关（2.39比1.22，p  = 0.002），较高的NIHSS评分（6.5 vs 4，p  = 0.034）和较低的PT水平（9.9 vs 13.4，p  = 0.007）。在多变量分析中，仅PT和CCI被证明是手术撤离后CSDH复发的独立危险因素（分别为p  = 0.033和p  = 0.024）。合并症更多的患者发生复发性CSDH的风险更高。CCI提供了一种预测CSDH患者复发的简单方法，在为患者提供咨询时应将其纳入决策过程。