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Sayed R, Gross S, Zamarud A, Nie L, Mudhar G, Eikermann M, Rupp S, Kim J, Babar M, Basam M, Yassari R, Gelfand Y. Predictors of mortality in chronic subdural hematoma evacuation. Neurosurg Rev 2023; 46:318. [PMID: 38036800 DOI: 10.1007/s10143-023-02213-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/19/2023] [Accepted: 11/05/2023] [Indexed: 12/02/2023]
Abstract
Chronic subdural hematoma (cSDH) is one of the most common types of intracranial hemorrhages, particularly in the elderly. Despite extensive research regarding cSDH diagnosis and treatment, there is conflicting data on predictors of postoperative mortality (POM). We conducted a large retrospective review of patients who underwent a cSDH evacuation at a single urban institution between 2015 and 2022. Data were collected from the electronic medical record on prior comorbidities, anticoagulation use, mental status on presentation, preoperative labs, and preoperative/postoperative imaging parameters. Univariate and multivariate analyses were conducted to analyze predictors of mortality. Mortality during admission for this cohort was 6.1%. Univariate analysis showed the mortality rate was higher in those presenting with a history of dialysis. In addition, those who presented with altered mental status, were intubated, and lower GCS scores had higher rates of POM. Usage of Coumadin was correlated with higher rates of POM. Examination of preoperative labs showed that patients who presented with anemia or thrombocytopenia had higher POM. Imaging data showed that cSDH volume and greatest dimension were correlated with higher rates of POM. Finally, patients that were not extubated postoperatively had higher rates of POM. Multivariate analysis showed that only altered mental status and being not being extubated postoperatively were correlated with a higher risk of mortality. In summation, we demonstrated that altered mental status and failure to extubate were independent predictors or mortality in cSDH evacuation. Interestingly, patient age was not a significant predictor of mortality.
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Affiliation(s)
- Rahman Sayed
- Department of Neurosurgery, Montefiore Medical Center, Bronx, NY, 10461-1900, USA.
| | - Suzanne Gross
- Department of Neurosurgery, Montefiore Medical Center, Bronx, NY, 10461-1900, USA
| | - Aroosa Zamarud
- Department of Neurosurgery, Stanford School of Medicine, Stanford, CA, 94305, USA
| | - Linda Nie
- Department of Neurosurgery, Montefiore Medical Center, Bronx, NY, 10461-1900, USA
| | - Gagandeep Mudhar
- Department of Neurosurgery, Montefiore Medical Center, Bronx, NY, 10461-1900, USA
| | - Matthias Eikermann
- Department of Anesthesiology, Montefiore Medical Center, Bronx, NY, 10461-1900, USA
| | - Samuel Rupp
- Department of Anesthesiology, Montefiore Medical Center, Bronx, NY, 10461-1900, USA
| | - Jinu Kim
- Department of Anesthesiology, Montefiore Medical Center, Bronx, NY, 10461-1900, USA
| | - Mustufa Babar
- Department of Neurosurgery, Montefiore Medical Center, Bronx, NY, 10461-1900, USA
| | - Mudaser Basam
- Department of Neurosurgery, Montefiore Medical Center, Bronx, NY, 10461-1900, USA
| | - Reza Yassari
- Department of Neurosurgery, Montefiore Medical Center, Bronx, NY, 10461-1900, USA
| | - Yaroslav Gelfand
- Department of Neurosurgery, Montefiore Medical Center, Bronx, NY, 10461-1900, USA
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Urquiaga JF, Patel MS, El Tecle N, Quadri N, Alexopoulos G, Bucholz RD, Mercier PJ, Kemp JM, Coppens J. Endoscope-Assisted Evacuation of Acute-on-Chronic Subdural Hematomas: A Single-Center Series. Cureus 2022; 14:e27575. [PMID: 36059304 PMCID: PMC9432857 DOI: 10.7759/cureus.27575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose: Acute subdural hematomas are frequent, highly morbid, and affect all age groups. The most common mechanism of injury is a low-velocity fall, and the incidence of the disease is growing due to increasingly aggressive antithrombotic and anticoagulant therapies. In this study, we aimed to share our experience with the endoscopic-assisted evacuation of acute subdural hematoma, a less invasive procedure compared to standard craniotomy. Methods: We retrospectively reviewed data of all consecutive patients aged 18 years and older who underwent endoscopic-assisted evacuation of acute-on-chronic subdural hematoma at our institution from 2015 to 2019. Preoperative, intraoperative, postoperative, and follow-up data were collected and reported. Statistical tests were done using Python statistical packages. Results: Of the 35 patients that underwent this procedure, 32 were 18 years and older. The median age was 69.5 years and 37.5% were female. Twenty patients (62.5%) were on antiplatelet therapy, and six patients (18.75%) were on anticoagulants upon presentation. A fall was the most common cause of trauma (71.88%). The median operative time was 107 minutes. The median length of stay in days and Glasgow Coma Scale (GCS) at discharge were 8.5 and 15, respectively. There were no surgical site infections or in-hospital mortality in this series. At the latest follow-up, the median GCS and modified Rankin Scale were 15 and 1, respectively. Conclusion: Evacuation of acute-on-chronic subdural hematomas can be performed safely and efficiently via a smaller craniotomy and with the assistance of an endoscope. This may represent a less invasive alternative than standard craniotomy/craniectomy in selected patients.
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Dekkers AJ, de Vries F, Zamanipoor Najafabadi AH, van der Hoeven EM, Verstegen MJT, Pereira AM, van Furth WR, Biermasz NR. Costs and Its Determinants in Pituitary Tumour Surgery. Front Endocrinol (Lausanne) 2022; 13:905019. [PMID: 35872986 PMCID: PMC9302462 DOI: 10.3389/fendo.2022.905019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 05/04/2022] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Value-based healthcare (VBHC) provides a framework to improve care by improving patient outcomes and reducing healthcare costs. To support value-based decision making in clinical practice we evaluated healthcare costs and cost drivers in perioperative care for pituitary tumour patients. METHODS We retrospectively assessed financial and clinical data for surgical treatment up to the first year after surgery of pituitary tumour patients treated between 2015 and 2018 in a Dutch tertiary referral centre. Multivariable regression analyses were performed to identify determinants of higher costs. RESULTS 271 patients who underwent surgery were included. Mean total costs (SD) were €16339 (13573) per patient, with the following cost determinants: surgery time (€62 per minute; 95% CI: 50, 74), length of stay (€1331 per day; 95% CI 1139, 1523), admission to higher care unit (€12154 in total; 95% CI 6413, 17895), emergency surgery (€10363 higher than elective surgery; 95% CI: 1422, 19305) and postoperative cerebrospinal fluid leak (€14232; 95% CI 9667, 18797). Intradural (€7128; 95% CI 10421, 23836) and combined transsphenoidal/transcranial surgery (B: 38494; 95% CI 29191, 47797) were associated with higher costs than standard. Further, higher costs were found in these baseline conditions: Rathke's cleft cyst (€9201 higher than non-functioning adenoma; 95% CI 1173, 17230), giant adenoma (€19106 higher than microadenoma; 95% CI 12336, 25877), third ventricle invasion (€14613; 95% CI 7613, 21613) and dependent functional status (€12231; 95% CI 3985, 20477). In patients with uncomplicated course, costs were €8879 (3210) and with complications €17551 (14250). CONCLUSIONS Length of hospital stay, and complications are the main drivers of costs in perioperative pituitary tumour healthcare as were some baseline features, e.g. larger tumors, cysts and dependent functional status. Costs analysis may correspond with healthcare resource utilization and guide further individualized care path development and capacity planning.
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Affiliation(s)
- Alies J. Dekkers
- Department of Medicine, Division of Endocrinology, Pituitary Center and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, Netherlands
- Department of Medicine, Center for Endocrine Tumours Leiden, Leiden University Medical Center, Leiden, Netherlands
- *Correspondence: Alies J. Dekkers,
| | - Friso de Vries
- Department of Medicine, Division of Endocrinology, Pituitary Center and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, Netherlands
- Department of Medicine, Center for Endocrine Tumours Leiden, Leiden University Medical Center, Leiden, Netherlands
| | - Amir H. Zamanipoor Najafabadi
- Department of Neurosurgery, Leiden University Medical Center, University Neurosurgical Center Holland, Leiden, Netherlands
| | | | - Marco J. T. Verstegen
- Department of Medicine, Center for Endocrine Tumours Leiden, Leiden University Medical Center, Leiden, Netherlands
- Department of Neurosurgery, Leiden University Medical Center, University Neurosurgical Center Holland, Leiden, Netherlands
| | - Alberto M. Pereira
- Department of Medicine, Division of Endocrinology, Pituitary Center and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, Netherlands
- Department of Medicine, Center for Endocrine Tumours Leiden, Leiden University Medical Center, Leiden, Netherlands
- Department of Endocrinology and Metabolism, Amsterdam University Medical Center, Meibergdreef 9, Amsterdam, Netherlands
| | - Wouter R. van Furth
- Department of Medicine, Center for Endocrine Tumours Leiden, Leiden University Medical Center, Leiden, Netherlands
- Department of Neurosurgery, Leiden University Medical Center, University Neurosurgical Center Holland, Leiden, Netherlands
| | - Nienke R. Biermasz
- Department of Medicine, Division of Endocrinology, Pituitary Center and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, Netherlands
- Department of Medicine, Center for Endocrine Tumours Leiden, Leiden University Medical Center, Leiden, Netherlands
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