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dc.contributor.authorChristopher, E
dc.contributor.authorPoon, MTC
dc.contributor.authorGlancz, LJ
dc.contributor.authorHutchinson, PJ
dc.contributor.authorKolias, AG
dc.contributor.authorBrennan, PM
dc.date.accessioned2019-11-25T21:45:38Z
dc.date.issued2019-06
dc.identifier.issn0344-5607
dc.identifier.issn1437-2320
dc.identifier.urihttp://hdl.handle.net/10026.1/15182
dc.description.abstract

Increasing age and lower pre-operative Glasgow coma score (GCS) are associated with worse outcome after surgery for chronic subdural haematoma (CSDH). Only few studies have quantified outcomes specific to the very elderly or comatose patients. We aim to examine surgical outcomes in these patient groups. We analysed data from a prospective multicentre cohort study, assessing the risk of recurrence, death, and unfavourable functional outcome of very elderly (≥ 90 years) patients and comatose (pre-operative GCS ≤ 8) patients following surgical treatment of CSDH. Seven hundred eighty-five patients were included in the study. Thirty-two (4.1%) patients had pre-operative GCS ≤ 8 and 70 (8.9%) patients were aged ≥ 90 years. A higher proportion of comatose patients had an unfavourable functional outcome (38.7 vs 21.7%; p = 0.03), although similar proportion of comatose (64.5%) and non-comatose patients (61.8%) functionally improved after surgery (p = 0.96). Compared to patients aged < 90 years, a higher proportion of patients aged ≥ 90 years had unfavourable functional outcome (41.2 vs 20.5%; p < 0.01), although approximately half had functional improvement following surgery. Mortality risk was higher in both comatose (6.3 vs 1.9%; p = 0.05) and very elderly (8.8 vs 1.1%; p < 0.01) groups. There was a trend towards a higher recurrence risk in the comatose group (19.4 vs 9.5%; p = 0.07). Surgery can still provide considerable benefit to very elderly and comatose patients despite their higher risk of morbidity and mortality. Further research would be needed to better identify those most likely to benefit from surgery in these groups.

dc.format.extent427-431
dc.format.mediumPrint-Electronic
dc.languageen
dc.language.isoeng
dc.publisherSpringer Science and Business Media LLC
dc.subjectChronic subdural hematoma
dc.subjectVery elderly
dc.subjectComatose
dc.subjectOutcome
dc.subjectSurgery
dc.titleOutcomes following surgery in subgroups of comatose and very elderly patients with chronic subdural hematoma
dc.typejournal-article
dc.typeJournal Article
dc.typeMulticenter Study
plymouth.author-urlhttps://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000467137500021&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=11bb513d99f797142bcfeffcc58ea008
plymouth.issue2
plymouth.volume42
plymouth.publication-statusPublished
plymouth.journalNeurosurgical Review
dc.identifier.doi10.1007/s10143-018-0979-4
plymouth.organisational-group/Plymouth
plymouth.organisational-group/Plymouth/Faculty of Health
plymouth.organisational-group/Plymouth/Users by role
dc.publisher.placeGermany
dcterms.dateAccepted2018-04-09
dc.rights.embargodate9999-12-31
dc.identifier.eissn1437-2320
dc.rights.embargoperiodNot known
rioxxterms.versionofrecord10.1007/s10143-018-0979-4
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.licenseref.startdate2019-06
rioxxterms.typeJournal Article/Review


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