Marshman, Laurence (2019) Letter to the editor re: standardized assessment of outcome and complications in chronic subdural hematoma: results from a large case series by Bucher B et al. Acta Neurochirurgica, 161 (12). pp. 2483-2484.

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Abstract

[Extract] Dear Editor

We read with interest the article by Bucher et al. [3] which commendably recorded all complications after chronic subdural hematoma (CSDH) surgery both by type and by the Clavien-Dindo classification. It is agreed that this should now become the standard practice. Importantly, the authors noted a post-operative morbidity of 38.3% [3]. A similarly high rate (47%) was also recently reported by Thomas et al. 11. Notably, both rates were significantly higher than the “standard” (10%) proposed by Brennan et al. [2]. Indeed, whilst Brennan et al. [2] had separated out recurrences, even including recurrences (9%) only resulted in a rate of 23% [11]: i.e., still significantly lower than both aforementioned studies [3, 11]. Importantly, the range of complication type observed by Brennan et al. [2] was singularly narrow: e.g., it did not include common complications expected in a CSDH age group, such as delirium [11]. Further, post-operative morbidity in a fractured neck-of-femur cohort (a group frequently compared with CSDH by neurosurgeons [5, 8, 11], including by Brennan et al. [2]) was similar (i.e., 45% [4]) to that of Bucher et al. [3] and Thomas et al. 11, but not Brennan et al. [2]. Thus, a “standard” post-operative morbidity of 10% [2] is untenable.

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