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Chronic subdural hematoma in patients over 90 years old in a super-aged society.

Tabuchi S, Kadowaki M - J Clin Med Res (2014)

Bottom Line: Clinical data were compared and analyzed.Postoperatively, mean neurological status was significantly improved in the surgery group (P < 0.01).Surgery for CSDH is safe and positively recommended even in super-aged patients over 90 years old if the patient's physical status is fair.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Tottori Prefectural Central Hospital, Tottori, Japan.

ABSTRACT

Background: Chronic subdural hematoma (CSDH) is one of the most common diseases in neurosurgical practice, particularly among aged patients. With the continuing increase in the aged population, further increases in incidence are expected. However, few studies have focused on CSDH in super-aged patients over 90 years old.

Methods: We retrospectively reviewed medical records for 20 consecutive patients over 90 years old with CSDH treated in our department between 2007 and 2013. The diagnosis of CSDH was confirmed by computed tomography (CT). Patients were divided into a surgery group and a conservative group. Surgical procedures included burr-hole surgery followed by insertion of a subdural drain under local anesthesia. Clinical data were compared and analyzed. Neurological status was evaluated according to the modified Rankin Scale at three time points: before suffering from CSDH; at the time of referral or admission to our department; and at discharge or 1 month after the first referral. Statistical tests were used to analyze data and values of P < 0.05 were considered significant.

Results: Mean age for the 20 cases was 92.6 years (range, 90 - 96 years). The leading symptoms in this population were hemiparesis and gait disturbance, followed by disturbance of consciousness and speech disturbance. Twelve patients underwent burr-hole surgery. Mean maximum thickness of subdural hematoma as measured on CT was significantly higher in the surgery group (28.2 ± 5.4 mm) than in the conservative group (17.0 ± 3.8 mm; P < 0.01). Postoperatively, mean neurological status was significantly improved in the surgery group (P < 0.01). After surgery, 66.7% of patients could return home directly from hospital. No significant perioperative complications directly related to surgery were encountered in the surgery group, except for transient postoperative restlessness and bruising of extremities due to falls.

Conclusions: Surgery for CSDH is safe and positively recommended even in super-aged patients over 90 years old if the patient's physical status is fair. Pre-illness status is the most important factor for considering operative indications and represents a limiting factor for postoperative outcomes in this age population.

No MeSH data available.


Related in: MedlinePlus

Neurological status as evaluated by mRS before the event (CSDH), on admission or referral to hospital, and at discharge after surgery or 1 month after treatment in the surgery group and conservative group, respectively. Statistical analysis was performed using the Wilcoxon/Kruskal-Wallis test and t-test. Error bars show standard deviation. NS, not significant. *P < 0.01.
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Figure 1: Neurological status as evaluated by mRS before the event (CSDH), on admission or referral to hospital, and at discharge after surgery or 1 month after treatment in the surgery group and conservative group, respectively. Statistical analysis was performed using the Wilcoxon/Kruskal-Wallis test and t-test. Error bars show standard deviation. NS, not significant. *P < 0.01.

Mentions: Mean mRS before the event, on admission/referral, and at discharge/1 month later are shown in Figure 1. After surgery, mean neurological status was significantly improved in the surgery group (P < 0.01), but was unchanged in the conservative group after treatment. Neurological status at discharge did not differ from status before onset of CSDH in the surgery group (Fig. 1).


Chronic subdural hematoma in patients over 90 years old in a super-aged society.

Tabuchi S, Kadowaki M - J Clin Med Res (2014)

Neurological status as evaluated by mRS before the event (CSDH), on admission or referral to hospital, and at discharge after surgery or 1 month after treatment in the surgery group and conservative group, respectively. Statistical analysis was performed using the Wilcoxon/Kruskal-Wallis test and t-test. Error bars show standard deviation. NS, not significant. *P < 0.01.
© Copyright Policy - open access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4125334&req=5

Figure 1: Neurological status as evaluated by mRS before the event (CSDH), on admission or referral to hospital, and at discharge after surgery or 1 month after treatment in the surgery group and conservative group, respectively. Statistical analysis was performed using the Wilcoxon/Kruskal-Wallis test and t-test. Error bars show standard deviation. NS, not significant. *P < 0.01.
Mentions: Mean mRS before the event, on admission/referral, and at discharge/1 month later are shown in Figure 1. After surgery, mean neurological status was significantly improved in the surgery group (P < 0.01), but was unchanged in the conservative group after treatment. Neurological status at discharge did not differ from status before onset of CSDH in the surgery group (Fig. 1).

Bottom Line: Clinical data were compared and analyzed.Postoperatively, mean neurological status was significantly improved in the surgery group (P < 0.01).Surgery for CSDH is safe and positively recommended even in super-aged patients over 90 years old if the patient's physical status is fair.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Tottori Prefectural Central Hospital, Tottori, Japan.

ABSTRACT

Background: Chronic subdural hematoma (CSDH) is one of the most common diseases in neurosurgical practice, particularly among aged patients. With the continuing increase in the aged population, further increases in incidence are expected. However, few studies have focused on CSDH in super-aged patients over 90 years old.

Methods: We retrospectively reviewed medical records for 20 consecutive patients over 90 years old with CSDH treated in our department between 2007 and 2013. The diagnosis of CSDH was confirmed by computed tomography (CT). Patients were divided into a surgery group and a conservative group. Surgical procedures included burr-hole surgery followed by insertion of a subdural drain under local anesthesia. Clinical data were compared and analyzed. Neurological status was evaluated according to the modified Rankin Scale at three time points: before suffering from CSDH; at the time of referral or admission to our department; and at discharge or 1 month after the first referral. Statistical tests were used to analyze data and values of P < 0.05 were considered significant.

Results: Mean age for the 20 cases was 92.6 years (range, 90 - 96 years). The leading symptoms in this population were hemiparesis and gait disturbance, followed by disturbance of consciousness and speech disturbance. Twelve patients underwent burr-hole surgery. Mean maximum thickness of subdural hematoma as measured on CT was significantly higher in the surgery group (28.2 ± 5.4 mm) than in the conservative group (17.0 ± 3.8 mm; P < 0.01). Postoperatively, mean neurological status was significantly improved in the surgery group (P < 0.01). After surgery, 66.7% of patients could return home directly from hospital. No significant perioperative complications directly related to surgery were encountered in the surgery group, except for transient postoperative restlessness and bruising of extremities due to falls.

Conclusions: Surgery for CSDH is safe and positively recommended even in super-aged patients over 90 years old if the patient's physical status is fair. Pre-illness status is the most important factor for considering operative indications and represents a limiting factor for postoperative outcomes in this age population.

No MeSH data available.


Related in: MedlinePlus