A retrospective chart review (RCR) of clinical outcomes of patients treated for chronic subdural hematomas (CSDH) at the Saint John Regional Hospital (SJRH)

Gabrielle Hibbert (a) and Dr. Andre LeRoux (b)
(a) Dalhousie Medicine New Brunswick
(b) Department of Neurosurgery, Saint John Regional Hospital, Horizon Health Network

​The optimal treatment approach to CSDH and if or how the use of antithrombotic medications prior to surgery influences patients outcomes remains inconclusive. A RCR of 147 patients treated for CSDHs conservatively or surgically with twist drill craniostomy (TDC), burr hole craniostomy (BHC), or craniotomy between January 2010 and June 2018 at the SJRH. Between surgical groups, there was no significant difference in patient’s post-operative hospital length of stay (LOS) (F (2, 110) = 0.089, p = .915, ƞp2 = .002), rates of reoperation (p = .446), or rates of post-operative seizures (p = .584). A comparison of patients on antiplatelet medications and patients not on antithrombotic therapy revealed no significant difference in post-operative hospital LOS (F(1, 87) = 0.134, p = .715, ƞp2 = .002), or rates of post-operative seizure (X2(1) = 1.269, p = .269, V =0.015). However, significantly more patients in the antiplatelet group required a second operation (X2(1) =3.886, p​ = .049, V = .048). Between patients on anticoagulant and not taking antithrombotic medications, no significant difference was found in post-operative hospital LOS  (F(1, 79) = 0.201, p = .655, ƞp2 = .003), rates of reoperation (p= .498), or rates of post-operative seizures (p = 1). The study suggest that TDC, BHC, and craniotomy are equally effective for managing CSDHs. Additionally, the use of antiplatelet or anticoagulant medications prior to surgery does not seem to impact LOS, or post-operative seizure rates.  However, antiplatelet use may increase reoperation rates.