Patient factors associated with 30-day morbidity, mortality, and length of stay after surgery for subdural hematoma: a study of the American College of Surgeons National Surgical Quality Improvement Program

Adam M. Lukasiewicz Department of Orthopaedics and Rehabilitation, and

Search for other papers by Adam M. Lukasiewicz in
Current site
Google Scholar
PubMed
Close
 MSc
,
Ryan A. Grant Neurosurgery, Yale School of Medicine, New Haven, Connecticut

Search for other papers by Ryan A. Grant in
Current site
Google Scholar
PubMed
Close
 MD, MS
,
Bryce A. Basques Department of Orthopaedics and Rehabilitation, and

Search for other papers by Bryce A. Basques in
Current site
Google Scholar
PubMed
Close
 MD, MHS
,
Matthew L. Webb Department of Orthopaedics and Rehabilitation, and

Search for other papers by Matthew L. Webb in
Current site
Google Scholar
PubMed
Close
 AB
,
Andre M. Samuel Department of Orthopaedics and Rehabilitation, and

Search for other papers by Andre M. Samuel in
Current site
Google Scholar
PubMed
Close
 BBA
, and
Jonathan N. Grauer Department of Orthopaedics and Rehabilitation, and

Search for other papers by Jonathan N. Grauer in
Current site
Google Scholar
PubMed
Close
 MD
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $536.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $636.00
USD  $45.00
USD  $536.00
USD  $636.00
Print or Print + Online Sign in

OBJECT

Surgery for subdural hematoma (SDH) is a commonly performed neurosurgical procedure. This study identifies patient characteristics associated with adverse outcomes and prolonged length of stay (LOS) in patients who underwent surgical treatment for SDH.

METHODS

All patients in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) who were treated via craniotomy or craniectomy for SDH between 2005 and 2012 were identified. Patient demographics, comorbidities, and 30-day outcomes were described. Multivariate regression was used to identify predictors of adverse events.

RESULTS

A total of 746 surgical procedures performed for SDH were identified and analyzed. Patients undergoing this procedure were 64% male with an average age (± SD) of 70.9 ± 14.1 years. The most common individual adverse events were death (17%) and intubation for more than 48 hours (19%). In total, 34% experienced a serious adverse event other than death, 8% of patients returned to the operating room (OR), and the average hospital LOS was 9.8 ± 9.9 days. In multivariate analysis, reduced mortality was associated with age less than 60 years (relative risk [RR] = 0.47, p = 0.017). Increased mortality was associated with gangrene (RR = 3.5, p = 0.044), ascites (RR = 3.00, p = 0.006), American Society of Anesthesiologists (ASA) Class 4 or higher (RR = 2.34, p = 0.002), coma (RR = 2.25, p < 0.001), and bleeding disorders (RR = 1.87, p = 0.003). Return to the OR was associated with pneumonia (RR = 3.86, p = 0.044), male sex (RR = 1.85, p = 0.015), and delirium (RR = 1.75, p = 0.016). Serious adverse events were associated with ventilator dependence preoperatively (RR = 1.86, p < 0.001), dialysis (RR = 1.44, p = 0.028), delirium (RR = 1.40, p = 0.005), ASA Class 4 or higher (RR = 1.36, p = 0.035), and male sex (RR = 1.29, p = 0.037). Similarly, LOS was increased in ventilator dependent patients by 1.56-fold (p = 0.002), in patients with ASA Class 4 or higher by 1.30-fold (p = 0.006), and in delirious patients by 1.29-fold (p = 0.008).

CONCLUSIONS

Adverse outcomes are common after surgery for SDH. In this study, 18% of the patients died within 30 days of surgery. Factors associated with adverse outcomes were identified. Patients and families should be counseled about the serious risks of morbidity and death associated with acute traumatic SDH requiring surgery.

ABBREVIATIONS

ACS = American College of Surgeons; ASA = American Society of Anesthesiologists; BMI = body mass index; CHF = congestive heart failure; CPT = Current Procedural Terminology; DVT = deep venous thrombosis; ICD-9 = International Classification of Diseases, Ninth Revision; LOS = length of stay; MI = myocardial infarction; NIS = National Inpatient Sample; NSQIP = National Surgical Quality Improvement Project; OR = operating room; PE = pulmonary embolism; RR = relative risk; SDH = subdural hematoma.
  • Collapse
  • Expand
  • 1

    American College of Surgeons: User Guide for the 2012 ACS NSQIP Participant Use Data File (https://www.facs.org/~/media/files/quality%20programs/nsqip/ugl2.ashx) Accessed June 16, 2015

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Bohl D, , Basques B, , Golinvaux N, , Baumgaertner M, & Grauer J: Nationwide Inpatient Sample and National Surgical Quality Improvement Program give different results in hip fracture studies. Clin Orthop Relat Res 472:16721680, 2014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Bohl DD, , Fu MC, , Golinvaux NS, , Basques BA, , Gruskay JA, & Grauer JN: The “July effect” in primary total hip and knee arthroplasty: analysis of 21,434 cases from the ACS-NSQIP database. J Arthroplasty 29:13321338, 2014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Busl KM, & Prabhakaran S: Predictors of mortality in nontraumatic subdural hematoma. J Neurosurg 119:12961301, 2013

  • 5

    Dent DL, , Croce MA, , Menke PG, , Young BH, , Hinson MS, & Kudsk KA, et al.: Prognostic factors after acute subdural hematoma. J Trauma 39:3643, 1995

  • 6

    Frontera JA, , Egorova N, & Moskowitz AJ: National trend in prevalence, cost, and discharge disposition after subdural hematoma from 1998–2007. Crit Care Med 39:16191625, 2011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Gruskay J, , Fu M, , Basques B, , Bohl D, , Buerba R, & Webb M, et al.: Factors affecting length of stay and complications following elective anterior cervical discectomy and fusion: A study of 2,164 patients from the ACS NSQIP database. J Spinal Disord Tech epub ahead of print 2014

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Hamilton MG, , Frizzell JB, & Tranmer BI: Chronic subdural hematoma: the role for craniotomy reevaluated. Neurosurgery 33:6772, 1993

  • 9

    Howard MA III, , Gross AS, , Dacey RG Jr, & Winn HR: Acute subdural hematomas: an age-dependent clinical entity. J Neurosurg 71:858863, 1989

  • 10

    Kalanithi P, , Schubert RD, , Lad SP, , Harris OA, & Boakye M: Hospital costs, incidence, and inhospital mortality rates of traumatic subdural hematoma in the United States. J Neurosurg 115:10131018, 2011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Khuri SF, , Henderson WG, , Daley J, , Jonasson O, , Jones RS, & Campbell DA Jr, et al.: Successful implementation of the Department of Veterans Affairs’ National Surgical Quality Improvement Program in the private sector: the Patient Safety in Surgery study. Ann Surg 248:329336, 2008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Koç RK, , Akdemir H, , Oktem IS, , Meral M, & Menkü A: Acute subdural hematoma: outcome and outcome prediction. Neurosurg Rev 20:239244, 1997

  • 13

    Lind CRP, , Lind CJ, & Mee EW: Reduction in the number of repeated operations for the treatment of subacute and chronic subdural hematomas by placement of subdural drains. J Neurosurg 99:4446, 2003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Markwalder TM, , Steinsiepe KF, , Rohner M, , Reichenbach W, & Markwalder H: The course of chronic subdural hematomas after burr-hole craniostomy and closed-system drainage. J Neurosurg 55:390396, 1981

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Missori P, , Fenga L, , Maraglino C, , Rocchi G, , Nardacci B, & Calderaro G, et al.: Spontaneous acute subdural hematomas. A clinical comparison with traumatic acute subdural hematomas. Acta Neurochir (Wien) 142:697701, 2000

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    National Institutes of Health: Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults—the evidence report. Obes Res 6:Suppl 2 51S209S, 1998. (Erratum in Obes Res 6:464, 1998)

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Seelig JM, , Becker DP, , Miller JD, , Greenberg RP, , Ward JD, & Choi SC: Traumatic acute subdural hematoma: major mortality reduction in comatose patients treated within four hours. N Engl J Med 304:15111518, 1981

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Taussky P, , Hidalgo ET, , Landolt H, & Fandino J: Age and salvageability: analysis of outcome of patients older than 65 years undergoing craniotomy for acute traumatic subdural hematoma. World Neurosurg 78:306311, 2012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Wilberger JE Jr, , Harris M, & Diamond DL: Acute subdural hematoma: morbidity, mortality, and operative timing. J Neurosurg 74:212218, 1991

  • 20

    Yanaka K, , Kamezaki T, , Yamada T, , Takano S, , Meguro K, & Nose T: Acute subdural hematoma—prediction of outcome with a linear discriminant function. Neurol Med Chir (Tokyo) 33:552558, 1993

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Zou G: A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol 159:702706, 2004

  • 22

    Zumkeller M, , Behrmann R, , Heissler HE, & Dietz H: Computed tomographic criteria and survival rate for patients with acute subdural hematoma. Neurosurgery 39:708713, 1996

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 720 188 98
Full Text Views 3385 399 5
PDF Downloads 2057 336 8
EPUB Downloads 0 0 0