Predictors of Outcome, Complications, and Recurrence after Chronic Subdural Hematoma Surgery

Aim: Chronic subdural hematoma (cSDH) is a frequent indication for neurosurgery in elderly patients. We were interested in predictors of outcome and complications of surgery (burr-hole or craniotomy) for cSDH.

Methods: For all patients undergoing surgery for cSDH from 2013 to 2017, we analyzed several clinical and radiological variables taken from our prospective patient registry. Outcome was measured with the Karnofsky Performance Scale (KPS). Complications were assessed according to the Clavien-Dindo grade (CDG).

Results: From a total of 435 cases, 166 (38.3%) presented a complication during the first 3 postoperative months. The CDG was grade 1 in 23 cases (5.3%), grade 2 in 62 (14.3%), 3a in 7 (1.6%), 3b in 64 (14.7%), 4a in 2 (0.5%), and 5 in 8 (1.8%). A change in KPS correlated with CDG (Spearman’s rho = −0.27, p < 0.001). A lack of improvement in KPS was predicted by the Charlson-Comorbidity index (CCI) > 1 (odds ratio 2.11, 95% confidence interval 1.30–3.43, p = 0.003).

Conclusions: Our data indicate that surgery for cSDH is a safe procedure despite the high average age of this patient population. Patient-related comorbidities, as reflected by the CCI, seem to be the most relevant for patient outcome.