Comparison Of Clinical Outcomes In Terms Of Morbidity And Mortality Between Subdural Hematoma Patients With Surgical Indications Who Received Operative Management And Non-Operative Management In A Tertiary Hospital
Volume 6 - Issue 11, November 2023 Edition
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Author(s)
Krisverlyn B. Bellosillo, MD, Donnabelle M. Chu, MD, FPNA, Nina M. Alvarez, MD
Keywords
clinical outcomes, conservative management, subdural hematoma, surgical indications, surgical management
Abstract
Subdural hematoma remains to be one of the common traumatic brain injuries associated with significant morbidity and mortality. This study aimed to compare the clinical outcomes in terms of morbidity and mortality between subdural hematoma patients with surgical indications who were managed operatively and patients who were managed conservatively in a tertiary hospital from 2015 to 2021. A total of 153 cases (60 underwent non-operative management while 90 underwent operative management) were documented. The average age of patients was 70.2 years with majority being male. Those who were managed operatively tend to have longer hospital stay (11.1 vs 4.9 days) and complications during admission (47.3% vs 21.7%) than those who were managed conservatively. mRS at discharge and mortality were not statistically different on both groups. The top 3 complications associated with subdural hematoma are pneumonia, constipation and seizure. The predictors of longer hospital stay in the operative group are hypertension and diabetes, whereas female sex and cardiovascular or neurologic diseases requiring antithrombotic medication in the non-operative group. The predictors of in-hospital complications in the operative group are hypertension, diabetes and severe GCS scores, while diabetes and malignancy in the non-operative group. Older age (60 years old and above), female sex, diabetes, chronic kidney disease and lower GCS Score on admission were significant predictive factors for unfavorable disability outcomes (mRS scores) at discharge in the operative group. Cardiovascular or neurologic diseases requiring antithrombotic medication and chronic kidney disease were significant predictors of mortality in the operative group. In terms of the reason behind non-operative management, majority (50 out of 60 patients) did not undergo surgical management because they remained neurologically stable during the admission. 23 out of these 50 patients had repeat in-hospital scan which showed interval partial lysis of the subdural hematoma. Hence, the clinician may consider initial conservative management in neurologically stable patients with large subdural hematomas, and follow-up with serial scans.
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