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Does the Timing of the Surgery Have a Major Role in Influencing the Outcome in Elders with Acute Subdural Hematomas?

Background: The incidence of traumatic acute subdural hematomas (ASDH) in the elderly is increasing. Despite surgical evacuation, these patients have poor survival and low rate of functional outcome, and surgical timing plays no clear role as a predictor. We investigated whether the timing of surger...

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Autores principales: Trevisi, Gianluca, Scerrati, Alba, Rustemi, Oriela, Ricciardi, Luca, Ius, Tamara, Auricchio, Anna Maria, De Bonis, Pasquale, Albanese, Alessio, Mangiola, Annunziato, Maugeri, Rosario, Nicolosi, Federico, Sturiale, Carmelo Lucio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9604688/
https://www.ncbi.nlm.nih.gov/pubmed/36294751
http://dx.doi.org/10.3390/jpm12101612
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author Trevisi, Gianluca
Scerrati, Alba
Rustemi, Oriela
Ricciardi, Luca
Ius, Tamara
Auricchio, Anna Maria
De Bonis, Pasquale
Albanese, Alessio
Mangiola, Annunziato
Maugeri, Rosario
Nicolosi, Federico
Sturiale, Carmelo Lucio
author_facet Trevisi, Gianluca
Scerrati, Alba
Rustemi, Oriela
Ricciardi, Luca
Ius, Tamara
Auricchio, Anna Maria
De Bonis, Pasquale
Albanese, Alessio
Mangiola, Annunziato
Maugeri, Rosario
Nicolosi, Federico
Sturiale, Carmelo Lucio
author_sort Trevisi, Gianluca
collection PubMed
description Background: The incidence of traumatic acute subdural hematomas (ASDH) in the elderly is increasing. Despite surgical evacuation, these patients have poor survival and low rate of functional outcome, and surgical timing plays no clear role as a predictor. We investigated whether the timing of surgery had a major role in influencing the outcome in these patients. Methods: We retrospectively retrieved clinical and radiological data of all patients ≥70 years operated on for post-traumatic ASDH in a 3 year period in five Italian hospitals. Patients were divided into three surgical timing groups from hospital arrival: ultra-early (within 6 h); early (6–24 h); and delayed (after 24 h). Outcome was measured at discharge using two endpoints: survival (alive/dead) and functional outcome at the Glasgow Outcome Scale (GOS). Univariate and multivariate predictor models were constructed. Results: We included 136 patients. About 33% died as a result of the consequences of ASDH and among the survivors, only 24% were in good functional outcome at discharge. Surgical timing groups appeared different according to presenting the Glasgow Outcome Scale (GCS), which was on average lower in the ultra-early surgery group, and radiological findings, which appeared worse in the same group. Delayed surgery was more frequent in patients with subacute clinical deterioration. Surgical timing appeared to be neither associated with survival nor with functional outcome, also after stratification for preoperative GCS. Preoperative midline shift was the strongest outcome predictor. Conclusions: An earlier surgery was offered to patients with worse clinical-radiological findings. Additionally, after stratification for GCS, it was not associated with better outcome. Among the radiological markers, preoperative midline shift was the strongest outcome predictor.
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spelling pubmed-96046882022-10-27 Does the Timing of the Surgery Have a Major Role in Influencing the Outcome in Elders with Acute Subdural Hematomas? Trevisi, Gianluca Scerrati, Alba Rustemi, Oriela Ricciardi, Luca Ius, Tamara Auricchio, Anna Maria De Bonis, Pasquale Albanese, Alessio Mangiola, Annunziato Maugeri, Rosario Nicolosi, Federico Sturiale, Carmelo Lucio J Pers Med Article Background: The incidence of traumatic acute subdural hematomas (ASDH) in the elderly is increasing. Despite surgical evacuation, these patients have poor survival and low rate of functional outcome, and surgical timing plays no clear role as a predictor. We investigated whether the timing of surgery had a major role in influencing the outcome in these patients. Methods: We retrospectively retrieved clinical and radiological data of all patients ≥70 years operated on for post-traumatic ASDH in a 3 year period in five Italian hospitals. Patients were divided into three surgical timing groups from hospital arrival: ultra-early (within 6 h); early (6–24 h); and delayed (after 24 h). Outcome was measured at discharge using two endpoints: survival (alive/dead) and functional outcome at the Glasgow Outcome Scale (GOS). Univariate and multivariate predictor models were constructed. Results: We included 136 patients. About 33% died as a result of the consequences of ASDH and among the survivors, only 24% were in good functional outcome at discharge. Surgical timing groups appeared different according to presenting the Glasgow Outcome Scale (GCS), which was on average lower in the ultra-early surgery group, and radiological findings, which appeared worse in the same group. Delayed surgery was more frequent in patients with subacute clinical deterioration. Surgical timing appeared to be neither associated with survival nor with functional outcome, also after stratification for preoperative GCS. Preoperative midline shift was the strongest outcome predictor. Conclusions: An earlier surgery was offered to patients with worse clinical-radiological findings. Additionally, after stratification for GCS, it was not associated with better outcome. Among the radiological markers, preoperative midline shift was the strongest outcome predictor. MDPI 2022-09-30 /pmc/articles/PMC9604688/ /pubmed/36294751 http://dx.doi.org/10.3390/jpm12101612 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Trevisi, Gianluca
Scerrati, Alba
Rustemi, Oriela
Ricciardi, Luca
Ius, Tamara
Auricchio, Anna Maria
De Bonis, Pasquale
Albanese, Alessio
Mangiola, Annunziato
Maugeri, Rosario
Nicolosi, Federico
Sturiale, Carmelo Lucio
Does the Timing of the Surgery Have a Major Role in Influencing the Outcome in Elders with Acute Subdural Hematomas?
title Does the Timing of the Surgery Have a Major Role in Influencing the Outcome in Elders with Acute Subdural Hematomas?
title_full Does the Timing of the Surgery Have a Major Role in Influencing the Outcome in Elders with Acute Subdural Hematomas?
title_fullStr Does the Timing of the Surgery Have a Major Role in Influencing the Outcome in Elders with Acute Subdural Hematomas?
title_full_unstemmed Does the Timing of the Surgery Have a Major Role in Influencing the Outcome in Elders with Acute Subdural Hematomas?
title_short Does the Timing of the Surgery Have a Major Role in Influencing the Outcome in Elders with Acute Subdural Hematomas?
title_sort does the timing of the surgery have a major role in influencing the outcome in elders with acute subdural hematomas?
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9604688/
https://www.ncbi.nlm.nih.gov/pubmed/36294751
http://dx.doi.org/10.3390/jpm12101612
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