Rahul Raj, Pihla Tommiska, Teemu Luoto, Ville Leinonen, Timo Koivisto, Sami Tetri, Jussi Posti, Kimmo Lönnrot
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Multivariable logistic regression was used to identify factors associated with failure to improve. Results Of the 568 patients with available mRS data at 6 months, 20% (n = 115) showed no improvement in mRS between the preoperative and 6-month period. Factors associated with failure to improve included pre-existing dementia (OR 2.62, 95% CI 1.21–5.66), use of a walker (OR 3.19, 95% CI 1.64–6.23), smaller hematoma width (OR 0.96, 95% CI 0.93–0.99), and lesser midline shift (OR 0.91, 95% CI 0.86–0.97). Despite this, 88% of patients had stable or improved residence status, and 85% maintained or improved mobility. Conclusion A substantial proportion of surgically treated CSDH patients do not improve in functional status. Dementia was a significant predictor of poor outcomes. Future research should focus to better identify patients at risk of poor outcomes in order to avoid overtreatment and explore possible alternative treatment strategies.","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"69 1","pages":""},"PeriodicalIF":6.0000,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Failure to improve—identifying risk factors for poor functional recovery following chronic subdural hematoma surgery\",\"authors\":\"Rahul Raj, Pihla Tommiska, Teemu Luoto, Ville Leinonen, Timo Koivisto, Sami Tetri, Jussi Posti, Kimmo Lönnrot\",\"doi\":\"10.1093/ageing/afaf056\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Background Chronic subdural hematoma (CSDH) is a common condition among older people living with frailty. Outcome after surgery is generally good, but there is a significant proportion of patients who do not benefit from surgery. This study aimed to identify predictors of failure to improve functional outcomes after CSDH surgery. Methods This is a post-hoc analysis of the nationwide FINISH trial, which enrolled 589 adult patients undergoing burr-hole drainage for symptomatic CSDH during 2020–22. Functional outcome was assessed using the modified Rankin Scale (mRS). Failure to improve was defined as unchanged or worsened mRS at 6 months compared to preoperative mRS. Multivariable logistic regression was used to identify factors associated with failure to improve. Results Of the 568 patients with available mRS data at 6 months, 20% (n = 115) showed no improvement in mRS between the preoperative and 6-month period. Factors associated with failure to improve included pre-existing dementia (OR 2.62, 95% CI 1.21–5.66), use of a walker (OR 3.19, 95% CI 1.64–6.23), smaller hematoma width (OR 0.96, 95% CI 0.93–0.99), and lesser midline shift (OR 0.91, 95% CI 0.86–0.97). Despite this, 88% of patients had stable or improved residence status, and 85% maintained or improved mobility. Conclusion A substantial proportion of surgically treated CSDH patients do not improve in functional status. Dementia was a significant predictor of poor outcomes. Future research should focus to better identify patients at risk of poor outcomes in order to avoid overtreatment and explore possible alternative treatment strategies.\",\"PeriodicalId\":7682,\"journal\":{\"name\":\"Age and ageing\",\"volume\":\"69 1\",\"pages\":\"\"},\"PeriodicalIF\":6.0000,\"publicationDate\":\"2025-03-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Age and ageing\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/ageing/afaf056\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"GERIATRICS & GERONTOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Age and ageing","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/ageing/afaf056","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GERIATRICS & GERONTOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景:慢性硬膜下血肿(CSDH)是老年人体弱多病的常见疾病。手术后的结果通常是好的,但有很大比例的患者不能从手术中获益。本研究旨在确定CSDH手术后功能改善失败的预测因素。方法:这是一项对全国FINISH试验的事后分析,该试验在2020 - 2022年期间招募了589名接受钻孔引流治疗症状性CSDH的成年患者。功能结局采用改良Rankin量表(mRS)评估。改善失败被定义为6个月时mRS与术前相比没有变化或恶化,多变量逻辑回归用于确定与改善失败相关的因素。结果568例患者6个月时有mRS数据,20% (n = 115)患者术前至6个月期间mRS无改善。与改善失败相关的因素包括先前存在的痴呆(OR 2.62, 95% CI 1.21-5.66)、使用助行器(OR 3.19, 95% CI 1.64-6.23)、较小的血肿宽度(OR 0.96, 95% CI 0.93-0.99)和较小的中线移位(OR 0.91, 95% CI 0.86-0.97)。尽管如此,88%的患者居住状况稳定或改善,85%的患者保持或改善了活动能力。结论相当一部分手术治疗的CSDH患者的功能状态没有得到改善。痴呆是不良预后的重要预测因子。未来的研究应侧重于更好地识别有不良预后风险的患者,以避免过度治疗,并探索可能的替代治疗策略。
Failure to improve—identifying risk factors for poor functional recovery following chronic subdural hematoma surgery
Background Chronic subdural hematoma (CSDH) is a common condition among older people living with frailty. Outcome after surgery is generally good, but there is a significant proportion of patients who do not benefit from surgery. This study aimed to identify predictors of failure to improve functional outcomes after CSDH surgery. Methods This is a post-hoc analysis of the nationwide FINISH trial, which enrolled 589 adult patients undergoing burr-hole drainage for symptomatic CSDH during 2020–22. Functional outcome was assessed using the modified Rankin Scale (mRS). Failure to improve was defined as unchanged or worsened mRS at 6 months compared to preoperative mRS. Multivariable logistic regression was used to identify factors associated with failure to improve. Results Of the 568 patients with available mRS data at 6 months, 20% (n = 115) showed no improvement in mRS between the preoperative and 6-month period. Factors associated with failure to improve included pre-existing dementia (OR 2.62, 95% CI 1.21–5.66), use of a walker (OR 3.19, 95% CI 1.64–6.23), smaller hematoma width (OR 0.96, 95% CI 0.93–0.99), and lesser midline shift (OR 0.91, 95% CI 0.86–0.97). Despite this, 88% of patients had stable or improved residence status, and 85% maintained or improved mobility. Conclusion A substantial proportion of surgically treated CSDH patients do not improve in functional status. Dementia was a significant predictor of poor outcomes. Future research should focus to better identify patients at risk of poor outcomes in order to avoid overtreatment and explore possible alternative treatment strategies.
期刊介绍:
Age and Ageing is an international journal publishing refereed original articles and commissioned reviews on geriatric medicine and gerontology. Its range includes research on ageing and clinical, epidemiological, and psychological aspects of later life.