Outcomes of chronic subdural hematoma in patients with liver cirrhosis

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OBJECTIVE

Burr hole craniostomy is an effective and simple procedure for treating chronic subdural hematoma (CSDH). However, the surgical outcomes and recurrence of CSDH in patients with liver cirrhosis (LC) remain unknown.

METHODS

A nationwide population-based cohort study was retrospectively conducted using data from the Taiwan National Health Insurance Research Database. The study included 29,163 patients who underwent first-time craniostomy for CSDH removal between January 1, 2001, and December 31, 2013. In total, 1223 patients with LC and 2446 matched non-LC control patients were eligible for analysis. All-cause mortality, surgical complications, repeat craniostomy, extended craniotomy, and long-term medical costs were analyzed.

RESULTS

The in-hospital mortality rate (8.7% vs 3.1% for patients with LC and non-LC patients, respectively), frequency of hospital admission, length of ICU stay, number of blood transfusions, and medical expenditures of patients with LC who underwent craniostomy for CSDH were considerably higher than those of non-LC control patients. Patients with LC tended to require an extended craniotomy to remove subdural hematomas in the hospital or during long-term follow-up. The surgical outcome worsened with an increase in the severity of LC.

CONCLUSIONS

Even for simple procedures following minor head trauma, LC remains a serious comorbidity with a poor prognosis.

ABBREVIATIONS CCI = Charlson Comorbidity Index; CIC = catastrophic illness certificate; CSDH = chronic SDH; CTP = Child-Turcotte-Pugh; ICD-9-CM = International Classification of Diseases, 9th Revision, Clinical Modification; LC = liver cirrhosis; NHI = National Health Insurance; NHIRD = NHI Research Database; SDH = subdural hematoma; TBI = traumatic brain injury.
Article Information

Contributor Notes

Correspondence An-Hsun Chou: Chang Gung Memorial Hospital, Taoyuan City, Taiwan. chou51chou51@gmail.com.INCLUDE WHEN CITING Published online February 2, 2018; DOI: 10.3171/2017.8.JNS171103.

C.C.C. and S.W.C. contributed equally to this work.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© Copyright 1944-2019 American Association of Neurological Surgeons

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