A retrospective comparative study of chronic subdural hematoma in patients with or without decreased level of consciousness

Abstract

Abstract Background In this retrospective cross-sectional study, we aimed to investigate the effects of preoperative decreased level of consciousness (DOC) on 6-month outcome and the risk factors that compromised the consciousness at admission in patients with chronic subdural hematoma (CSDH). Methods From August 2011 to August 2017, a total of 1075 patients were consecutively included and assigned into two groups based on consciousness assessment: 1035 cases with full consciousness and 40 cases with preoperative DOC. The Glasgow Coma Scale was used to assess the consciousness status. The clinical features, radiological findings, and clinical outcomes were compared between patients with and without preoperative DOC. A least absolute shrinkage and selection operator (LASSO) method was used for variable selection, and then the multivariate logistic regression was constructed. Results With a median age of 66 years old, 182 (16.9%) females and 893 (83.1%) males were included. Preoperative coagulopathy ( p = 0.003) and stroke ( p = 0.022) were more frequently observed in patients with DOC after univariate analysis. Receiving comparable treatments, patients with DOC developed more postoperative pneumonia ( p = 0.041) and worse 6-month modified Rankin Scale (mRS) ( p = 0.004). LASSO found age, duration of symptoms, stroke, smoke, coagulopathy, and total hematoma volume appropriate to include in the final model. After multivariate logistic regression analysis, age above 70 (Odds Ratio 2.18, 95% CI 1.10–4.35, p = 0.025) and coagulopathy (Odds Ratio 2.89, 95% CI 1.52–5.62, p = 0.001) were associated with increased odds of developing preoperative DOC in CSDH patients. Conclusions CSDH patients with preoperative DOC tended to have postoperative pneumonia and worse mRS at 6-month. The old age (age above 70) and preoperative coagulopathy might be associated with the compromised consciousness at admission. Identifying these associated factors early can assist neurosurgeons in clinical risk stratification and optimizing preoperative care to potentially mitigate complications.