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Radiological mass effect and neurological status are associated with mortality after burr-hole drainage for chronic subdural hematoma: a 10-year cohort study.

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Τίτλος: Radiological mass effect and neurological status are associated with mortality after burr-hole drainage for chronic subdural hematoma: a 10-year cohort study.
Συγγραφείς: Yıldızhan S; Department of Neurosurgery, Afyonkarahisar Health Sciences University Health Application and Research Center, Afyonkarahisar, Turkey. serhatyildizhan07@gmail.com., Rakip U; Department of Neurosurgery, Afyonkarahisar Health Sciences University Health Application and Research Center, Afyonkarahisar, Turkey., Canbek İ; Department of Neurosurgery, Afyonkarahisar Health Sciences University Health Application and Research Center, Afyonkarahisar, Turkey., Boyacı MG; Department of Neurosurgery, Afyonkarahisar Health Sciences University Health Application and Research Center, Afyonkarahisar, Turkey., Korkmaz S; Department of Neurosurgery, Afyonkarahisar Health Sciences University Health Application and Research Center, Afyonkarahisar, Turkey., Aslan A; Department of Neurosurgery, Afyonkarahisar Health Sciences University Health Application and Research Center, Afyonkarahisar, Turkey.
Πηγή: Neurosurgical review [Neurosurg Rev] 2026 Jul 20; Vol. 49 (1). Date of Electronic Publication: 2026 Jul 20.
Τύπος έκδοσης: Journal Article
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Springer Berlin Heidelberg Country of Publication: Germany NLM ID: 7908181 Publication Model: Electronic Cited Medium: Internet ISSN: 1437-2320 (Electronic) Linking ISSN: 03445607 NLM ISO Abbreviation: Neurosurg Rev Subsets: MEDLINE
Imprint Name(s): Publication: Berlin : Springer Berlin Heidelberg
Original Publication: Berlin : Walter De Gruyter
Ιατρικοί όροι (MeSH): Hematoma, Subdural, Chronic*/surgery , Hematoma, Subdural, Chronic*/mortality , Hematoma, Subdural, Chronic*/diagnostic imaging , Drainage*/methods , Drainage*/mortality , Trephining*, Postoperative Complications/mortality ; Humans ; Aged ; Female ; Retrospective Studies ; Male ; Hospital Mortality ; Aged, 80 and over ; Cohort Studies ; Brain Edema ; Middle Aged ; Glasgow Coma Scale ; Tomography, X-Ray Computed
Περίληψη: Chronic subdural hematoma (CSDH) is increasingly common in older adults and in patients receiving antithrombotic therapy. Although burr-hole drainage is generally safe and effective, perioperative mortality remains a concern, and reliable preoperative predictors are incompletely defined. We aimed to identify independent preoperative predictors of in-hospital mortality after burr-hole drainage for CSDH, with explicit characterization of causes of death, comorbidity burden, and the discriminative performance of candidate predictors. This single-center retrospective cohort study included 121 consecutive adult patients surgically treated for CSDH between January 2015 and December 2024. Preoperative variables included demographics, Glasgow Coma Scale (GCS) score, hematoma thickness, midline shift (MLS), cerebral edema on CT, antithrombotic use, and a comprehensive set of comorbidities (chronic kidney disease, chronic obstructive pulmonary disease, congestive heart failure, coronary artery disease, atrial fibrillation, diabetes mellitus, dementia, malignancy). Intensive care unit admission and postoperative complications were also recorded. The primary outcome was in-hospital mortality. Causes of death were systematically categorized. Associations were evaluated using Firth penalized logistic regression. Discriminative performance was assessed using receiver operating characteristic (ROC) analysis with bootstrap confidence intervals. A prespecified exploratory interaction analysis between cerebral edema and significant midline shift was performed. In-hospital mortality was 12.4% (15/121). The principal cause of death was cerebral herniation (9/15, 60.0%); extracranial complications (respiratory, septic, cardiac) accounted for 6/15 (40.0%). In the original multivariable Firth model, GCS ≤ 13 (adjusted OR 11.71, 95% CI 2.82-48.61, p < 0.001) and cerebral edema (adjusted OR 8.90, 95% CI 1.93-40.98, p = 0.005) were independently associated with mortality. In an extended model incorporating comorbidities, chronic kidney disease (OR 23.78, p = 0.025) and congestive heart failure (OR 42.39, p = 0.043) emerged as additional independent predictors, while cerebral edema (OR 61.89, p = 0.008) and GCS ≤ 13 (OR 5.80, p = 0.032) retained their associations. Combined model discrimination was excellent (Model 1: AUC 0.920; Model 2 with comorbidities: AUC 0.958). Subgroup analysis demonstrated a marked mortality gradient: 0% in patients with neither cerebral edema nor significant midline shift (n = 59), versus 72.2% in patients with both findings (n = 18). The exploratory interaction term (cerebral edema × midline shift ≥ 5 mm) was directionally consistent with synergy but did not reach statistical significance (OR 39.19, 95% CI 0.26-∞, p = 0.152), reflecting limited statistical power. Preoperative neurological impairment and cerebral edema are independently associated with in-hospital mortality after burr-hole drainage for CSDH. The coexistence of cerebral edema and significant midline shift identifies a clinically recognizable high-risk phenotype that may warrant heightened perioperative attention. Renal and cardiac comorbidities further contribute to mortality risk. These findings are hypothesis-generating and require validation in larger, prospective cohorts before incorporation into clinical risk stratification.Clinical trial number: not applicable.
(© 2026. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Competing Interests: Declarations. Ethics Approval: This study was approved by the Non-Interventional Scientific Research Ethics Committee of Afyonkarahisar Health Sciences University (Meetingdate: 03.04.2026; Meeting No: 2026/05; Decision No: 289). All procedures were performed in accordance with the ethical standards of the institutionalresearch committee and with the 1964 Declaration of Helsinki and its later amendments. Consent to Participate: The requirement for informed consent was waived due to the retrospective study design. Consent to Publish: Not applicable. Competing interests: The authors declare no competing interests. Artificial Intelligence Use: AI-assisted language editing tools were used to improve the clarity and readability of the manuscript text. All scientific content, data analysis, and conclusions are the sole responsibility of the authors.
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Contributed Indexing: Keywords: Burr-hole drainage; Cerebral edema; Chronic subdural hematoma; Mass effect; Midline shift; Mortality
Entry Date(s): Date Created: 20260719 Date Completed: 20260719 Latest Revision: 20260719
Update Code: 20260720
DOI: 10.1007/s10143-026-04405-8
PMID: 42472980
Βάση Δεδομένων: MEDLINE
Περιγραφή
ISSN:1437-2320
DOI:10.1007/s10143-026-04405-8