Research Article

Factors associated with unfavourable outcome after Burr Hole drainage in Subdural Hematoma (SDH) at Sanglah General Hospital, Bali, Indonesia

I Gusti Ngurah Purnomo , I Wayan Niryana, Nyoman Golden

I Gusti Ngurah Purnomo
General Surgery Resident, Department of Surgery, Faculty of Medicine, Universitas Udayana, Sanglah General Hospital, Bali, Indonesia. Email: ngurahpurnomonc9@gmail.com

I Wayan Niryana
Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Universitas Udayana, Sanglah General Hospital, Bali, Indonesia

Nyoman Golden
Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Universitas Udayana, Sanglah General Hospital, Bali, Indonesia
Online First: July 19, 2020 | Cite this Article
Purnomo, I., Niryana, I., Golden, N. 2020. Factors associated with unfavourable outcome after Burr Hole drainage in Subdural Hematoma (SDH) at Sanglah General Hospital, Bali, Indonesia. Intisari Sains Medis 11(2): 561-565. DOI:10.15562/ism.v11i2.731


Background: Subdural hematoma is a neurosurgical disorder that often occurs in the elderly with simple, relatively fast and minimally invasive surgical therapy, but has a high postoperative mortality rate due to unfavourable outcome. This study aims to evaluate factors associated with unfavourable outcome after burr hole drainage in a subdural hematoma (SDH) at Sanglah General Hospital, Bali, Indonesia.

Method: A prospective cohort study was conducted among 60 respondents to determine factors influencing the outcome of patients with subdural hematoma after burr hole drainage.  The independent variables in this study included age, comorbid factors, trauma onset, GCS, hematoma thickness, and midline shift.  Dependent variables include the Glasgow Outcome Scale (GOS), which is divided into 2 groups, favourable outcome, and unfavourable outcome. Data were analyzed using SPSS version 17 for Windows.

Results: There were 19 respondents (31.7%) had unfavourable outcomes and 41 respondents (68.3%) had favourable outcomes.  From the bivariate analysis, significant associated risk factors were found in the onset of trauma (p=0.048), GCS (p=0.000), hematoma thickness (p = 0.000), and midline shift (p=0.000).  From the multivariate analysis, it was found that low GCS was the most dominant risk factor for the unfavourable outcome following burr hole drainage (OR=22.30; 95% CI= 2.22-223.80; p=0.008)

Conclusion: This study concludes that low GCS was the most dominant risk factor for unfavourable outcome in patients with subdural hematoma after burr hole drainage

References

Wilberger JE Jr, Harris M, Diamond DL. Acute subdural hematoma: morbidity, mortality, and operative timing. J Neurosurg. 1991;74(2):212-218.

Lee JJ, Segar DJ, Morrison JF, Mangham WM, Lee S, Asaad WF. Subdural hematoma as a major determinant of short-term outcomes in traumatic brain injury. J Neurosurg. 2018;128(1):236-249.

Balser D, Farooq S, Mehmood T, Reyes M, Samadani U. Actual and projected incidence rates for chronic subdural hematomas in United States Veterans Administration and civilian populations. J Neurosurg. 2015;123(5):1209-1215.

Weigel R, Krauss JK, Schmiedek P. Concepts of neurosurgical management of chronic subdural haematoma: historical perspectives. Br J Neurosurg. 2004;18(1):8-18.

Weimer JM, Gordon E, Frontera JA. Predictors of Functional Outcome After Subdural Hematoma: A Prospective Study. Neurocrit Care. 2017;26(1):70-79.

Bokka S, Trivedi A. Histopathological study of the outer membrane of the dura mater in chronic sub dural hematoma: Its clinical and radiological correlation. Asian J Neurosurg. 2016;11(1):34-38.

Bin Zahid A, Balser D, Thomas R, Mahan MY, Hubbard ME, Samadani U. Increase in brain atrophy after subdural hematoma to rates greater than associated with dementia. J Neurosurg. 2018;129(6):1579-1587.

Karibe H, Hayashi T, Narisawa A, Kameyama M, Nakagawa A, Tominaga T. Clinical Characteristics and Outcome in Elderly Patients with Traumatic Brain Injury: For Establishment of Management Strategy. Neurol Med Chir (Tokyo). 2017;57(8):418-425.

Syahrul S, Imran I, Fajri N. Clinical characteristics of traumatic brain injury patients in Dr. Zainoel Abidin Public Hospital Banda Aceh, Indonesia. Bali Medical Journal. 2020;9(1):194-200

Edlmann E, Giorgi-Coll S, Whitfield PC, Carpenter KLH, Hutchinson PJ. Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy. J Neuroinflammation. 2017;14(1):108.

Adhiyaman V, Asghar M, Ganeshram KN, Bhowmick BK. Chronic subdural haematoma in the elderly. Postgrad Med J. 2002;78(916):71-75.

Gelabert-González M, Iglesias-Pais M, García-Allut A, Martínez-Rumbo R. Chronic subdural haematoma: surgical treatment and outcome in 1000 cases. Clin Neurol Neurosurg. 2005;107(3):223-229.

Abe Y, Maruyama K, Yokoya S, Noguchi A, Sato E, Nagane M, et al. Outcomes of chronic subdural hematoma with preexisting comorbidities causing disturbed consciousness. J Neurosurg. 2017;126(4):1042-1046.

Rovlias A, Theodoropoulos S, Papoutsakis D. Chronic subdural hematoma: Surgical management and outcome in 986 cases: A classification and regression tree approach. Surg Neurol Int. 2015;6:127.

Kim DH, Park ES, Kim MS, et al. Correlation between Head Trauma and Outcome of Chronic Subdural Hematoma. Korean J Neurotrauma. 2016;12(2):94-100.

Kim DI, Kim JH, Kang HI, Moon BG, Kim JS, Kim DR. Impact of Time Interval between Trauma Onset and Burr Hole Surgery on Recurrence of Late Subacute or Chronic Subdural Hematoma. J Korean Neurosurg Soc. 2016;59(5):498-504.

Wang YQ, Gu MC, Shi Q, Wang WP, Liu JY, Zhang ZD, et al. Chronic Subdural Hematoma with Hypodense on CT-Scan in the Elderly: Surgical Drainage or Conservative Treatment. 2016;7(3):1-9

Yang AI, Balser DS, Mikheev A, et al. Cerebral atrophy is associated with development of chronic subdural haematoma. Brain Inj. 2012;26(13-14):1731-1736.

Kim TH, Park ES, Park JB, Kwon SC, Lyo IU, Sim HB, et al. Outcome and Prognostic Factors in Patients with Chronic Subdural Hematoma Classified According to the Initial Glasgow Coma Scale Score. The Nerve. 2017;3(1):25-31

Amirjamshidi A, Abouzari M, Rashidi A. Glasgow Coma Scale on admission is correlated with postoperative Glasgow Outcome Scale in chronic subdural hematoma. J Clin Neurosci. 2007;14(12):1240-1241.


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