TY - JOUR
T1 - Surgery After Primary Dexamethasone Treatment for Patients with Chronic Subdural Hematoma—A Retrospective Study
AU - Holl, Dana C.
AU - Fakhry, Rahman
AU - Dirven, Clemens M.F.
AU - te Braake, Florien A.L.
AU - Begashaw, Orit K.
AU - Moudrous, Walid
AU - Droger, S. Mirjam
AU - Asahaad, Nabil
AU - de Brabander, Christiaan
AU - Plas, Gerben J.J.
AU - Jacobs, Bram
AU - van der Naalt, Joukje
AU - den Hertog, Heleen M.
AU - van der Gaag, Niels A.
AU - Jellema, Korné
AU - Dammers, Ruben
AU - Lingsma, Hester F.
N1 - Funding Information:
Conflict of interest statement: This study was gratefully supported by a grant from The Netherlands Organisation for Health Research and Development (ZonMw project number 843002824 ) and the Erasmus MC (Mrace, project number 2016–16118 ; EMC).
Publisher Copyright:
© 2022 The Authors
PY - 2022/6
Y1 - 2022/6
N2 - Background: We aimed to quantify the need for additional surgery in patients with chronic subdural hematoma (CSDH) primarily treated with dexamethasone and to identify patient characteristics associated with additional surgery. Methods: Data were retrospectively collected from 283 patients with CSDH, primarily treated with dexamethasone, in 3 hospitals from 2008 to 2018. Primary outcome was the need for additional surgery. The association between baseline characteristics and additional surgery was analyzed with univariable and multivariable logistic regression analysis and presented as adjusted odds ratios (aOR). Results: In total, 283 patients with CSDH were included: 146 patients (51.6%) received 1 dexamethasone course (DXM group), 30 patients (10.6%) received 2 dexamethasone courses (DXM-DXM group), and 107 patients (37.8%) received additional surgery (DXM-SURG group). Patients who underwent surgery more often had a Markwalder Grading Scale of 2 (as compared with 1, aOR 2.05; 95% confidence interval [CI] 0.90–4.65), used statins (aOR 2.09; 95% CI 1.01–4.33), had a larger midline shift (aOR 1.10 per mm; 95% CI 1.01–1.21) and had larger hematoma thickness (aOR 1.16 per mm; 95% CI 1.09–1.23), had a bilateral hematoma (aOR 1.85; 95% CI 0.90–3.79), and had a separated hematoma (as compared with homogeneous, aOR 1.77; 95% CI 0.72–4.38). Antithrombotics (aOR 0.45; 95% CI 0.21–0.95) and trabecular hematoma (as compared with homogeneous, aOR 0.31; 95% CI 0.12–0.77) were associated with a lower likelihood of surgery. Conclusions: More than one-third of patients with CSDH primarily treated with dexamethasone received additional surgery. These patients were more severely affected amongst others with larger hematomas.
AB - Background: We aimed to quantify the need for additional surgery in patients with chronic subdural hematoma (CSDH) primarily treated with dexamethasone and to identify patient characteristics associated with additional surgery. Methods: Data were retrospectively collected from 283 patients with CSDH, primarily treated with dexamethasone, in 3 hospitals from 2008 to 2018. Primary outcome was the need for additional surgery. The association between baseline characteristics and additional surgery was analyzed with univariable and multivariable logistic regression analysis and presented as adjusted odds ratios (aOR). Results: In total, 283 patients with CSDH were included: 146 patients (51.6%) received 1 dexamethasone course (DXM group), 30 patients (10.6%) received 2 dexamethasone courses (DXM-DXM group), and 107 patients (37.8%) received additional surgery (DXM-SURG group). Patients who underwent surgery more often had a Markwalder Grading Scale of 2 (as compared with 1, aOR 2.05; 95% confidence interval [CI] 0.90–4.65), used statins (aOR 2.09; 95% CI 1.01–4.33), had a larger midline shift (aOR 1.10 per mm; 95% CI 1.01–1.21) and had larger hematoma thickness (aOR 1.16 per mm; 95% CI 1.09–1.23), had a bilateral hematoma (aOR 1.85; 95% CI 0.90–3.79), and had a separated hematoma (as compared with homogeneous, aOR 1.77; 95% CI 0.72–4.38). Antithrombotics (aOR 0.45; 95% CI 0.21–0.95) and trabecular hematoma (as compared with homogeneous, aOR 0.31; 95% CI 0.12–0.77) were associated with a lower likelihood of surgery. Conclusions: More than one-third of patients with CSDH primarily treated with dexamethasone received additional surgery. These patients were more severely affected amongst others with larger hematomas.
UR - http://www.scopus.com/inward/record.url?scp=85127555813&partnerID=8YFLogxK
U2 - 10.1016/j.wneu.2022.03.014
DO - 10.1016/j.wneu.2022.03.014
M3 - Article
C2 - 35276391
AN - SCOPUS:85127555813
SN - 1878-8750
VL - 162
SP - e358-e368
JO - World Neurosurgery
JF - World Neurosurgery
ER -