Objective

To examine the population-based incidence, complications, and total, direct hospital costs of chronic subdural hematoma (CSDH) treatment in a neurosurgical clinic during a 26-year period. The aim was also to estimate the necessity of planned postoperative follow-up computed tomography (CT).

Methods

A retrospective cohort (1990–2015) of adult patients living in Pirkanmaa, Finland, with a CSDH was identified using ICD codes and verified by medical records (n = 1148, median age = 76 years, men = 65%). Data collection was performed from medical records. To estimate the total, direct hospital costs, all costs from hospital admission until the last neurosurgical follow-up visit were calculated. All patients were followed until death or the end of 2017. The annual number of inhabitants in the Pirkanmaa Region was obtained from the Statistics Finland (Helsinki, Finland).

Results

The incidence of CSDH among the population 80 years or older has increased among both operatively (from 36.6 to 91/100,000/year) and non-operatively (from 4.7 to 36.9/100,000/year) treated cases. Eighty-five percent (n = 978) underwent surgery. Routine 4–6 weeks’ postoperative follow-up CT increased the number of re-operations by 18% (n = 49). Most of the re-operations (92%) took place within 2 months from the primary operation. Patients undergoing re-operations suffered more often from seizures (10%, n = 28 vs 3.9%, n = 27; p < 0.001), empyema (4.3%, n = 12 vs 1.1%, n = 8; p = 0.002), and pneumonia (4.7%, n = 13 vs 1.4%, n = 12; p = 0.008) compared with patients with no recurrence. The treatment cost for recurrent CSDHs was 132% higher than the treatment cost of non-recurrent CSDHs, most likely because of longer hospital stay for re-admissions and more frequent outpatient follow-up with CT. The oldest group of patients, 80 years or older, was not more expensive than the others, nor did this group have more frequent complications, besides pneumonia.

Conclusions

Based on our population-based study, the number of CSDH patients has increased markedly during the study period (1990–2015). Reducing recurrences is crucial for reducing both complications and costs. Greater age was not associated with greater hospital costs related to CSDH. A 2-month follow-up period after CSDH seems sufficient for most, and CT controls are advocated only for symptomatic patients.

中文翻译：

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慢性硬膜下血肿的发生，并发症和财务影响。

目的

在26年的时间里，在神经外科诊所检查慢性硬脑膜下血肿（CSDH）治疗的人群发病率，并发症和总的直接医院费用。目的还在于估计计划的术后随访计算机体层摄影（CT）的必要性。

方法

回顾性队列研究（1990-2015年），采用ICD码对居住在芬兰皮尔肯玛（Pirkanmaa）的成年患者进行CSDH治疗，并通过医疗记录进行了验证（n = 1148，中位年龄= 76岁，男性= 65％）。从病历收集数据。为了估算总的直接医院费用，计算了从入院到最后一次神经外科随访的所有费用。所有患者均接受随访，直至死亡或至2017年底。皮尔坎玛地区的年居民人数来自芬兰统计局（芬兰赫尔辛基）。

结果

在手术（非手术）病例（从36.6增至91 / 100,000 /年）和非手术（从4.7至36.9 / 100,000 /年）的病例中，80岁以上人群中CSDH的发生率均有所增加。百分之八十五（n = 978）接受了手术。术后4-6周的常规随访CT使再次手术的次数增加了18％（n = 49）。大部分重新手术（92％）发生在初次手术后的2个月内。接受再手术的患者更容易发生癫痫发作（10％，n = 28 vs 3.9％，n = 27; p <0.001），脓胸（4.3％，n = 12 vs 1.1％，n = 8; p = 0.002）和肺炎（4.7％，n= 13比1.4％，n = 12；p = 0.008）与无复发的患者相比。复发性CSDH的治疗费用比非复发性CSDH的治疗费用高132％，这很可能是因为住院时间较长，以便再次入院，以及CT的门诊随访频率更高。80岁以上的年龄最大的一组患者，其费用并不比其他组贵，除肺炎外，该组也没有更常见的并发症。

结论

根据我们基于人群的研究，在研究期间（1990年至2015年），CSDH患者的数量显着增加。减少复发对于减少并发症和成本至关重要。年龄的增加与CSDH相关的医院费用增加无关。CSDH后的2个月随访期似乎对大多数人来说就足够了，并且仅对有症状的患者主张CT对照。