Clinical study| Volume 75, P35-39, May 2020

Download started.


Specific causes and predictors of readmissions following acute and chronic subdural hematoma evacuation

Published:March 31, 2020DOI:


      • Overall, chronic SDH readmissions are predominantly attributable to recurrence.
      • Acute SDH readmissions are more likely due to a variety of neurologic complications.
      • INR derangements or hypertension were predictive of readmissions in chronic SDH.
      • In-hospital adverse events were associated with readmission following acute SDH.


      Patients treated with craniotomy for subdural hematoma (SDH) evacuation have a higher readmission incidence when compared to other neurosurgical patients. Factors predictive of readmission following craniotomy for SDH are incompletely understood. The National Surgical Quality Improvement (NSQIP) database was queried for all patients treated by craniotomy for SDH of any etiology (e.g. acute, chronic, spontaneous, traumatic) during the study period (2012–2014). Patients requiring repeat hospitalization within 30 days of surgery were identified and classified by reason for readmission. Binary logistic regression analysis was used to identify predictors of readmission. 1024 patients met inclusion criteria, among whom 109 (10.6%) were readmitted within 30 days. The most common causes of readmission were recurrent SDH (n = 27; 33.3%), seizure (n = 8; 9.9%), new neurological deficit (n = 6; 7.4%), stroke (n = 6; 7.4%), and altered mental status (AMS) (n = 6; 7.4%). Multivariable modeling identified hypertension requiring medication (OR = 2.78, P = 0.013) and abnormal INR (OR = 2.66, P = 0.035) as significantly associated with readmission following chronic SDH, while postoperative UTI (OR = 3.64, P = 0.01) and stroke (OR = 4.86, P = 0.018) were significant predictors of readmission following acute SDH. Readmission was associated with recurrent hemorrhage after chronic/spontaneous SDH, while seizures, AMS, and neurological deficits drove readmissions after acute/traumatic SDH. Careful management of anticoagulation and antihypertensive medications may be helpful in reducing the risk of readmission following craniotomy for chronic SDH.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Clinical Neuroscience
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Ansari S.F.
        • Yan H.
        • Zou J.
        • Worth R.M.
        • Barbaro N.M.
        Hospital length of stay and readmission rate for neurosurgical patients.
        Neurosurgery. 2018; 82: 173-181
        • 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: 1209-1215
        • Balser D.
        • Rodgers S.D.
        • Johnson B.
        • Shi C.
        • Tabak E.
        • Samadani U.
        Evolving management of symptomatic chronic subdural hematoma: experience of a single institution and review of the literature.
        Neurol Res. 2013; 35: 233-242
        • Bhagat R.
        • Bronsert M.R.
        • Juarez-Colunga E.
        • Weyant M.J.
        • Mitchell J.D.
        • Glebova N.O.
        • et al.
        Postoperative complications drive unplanned readmissions after esophagectomy for cancer.
        Ann Thorac Surg. 2018; 105: 1476-1482
        • Chon K.-H.
        • Lee J.-M.
        • Koh E.-J.
        • Choi H.-Y.
        Independent predictors for recurrence of chronic subdural hematoma.
        Acta Neurochir (Wien). 2012; 154: 1541-1548
        • Eapen Zubin J.
        • Reed Shelby D.
        • Yanhong Li
        • et al.
        Do countries or hospitals with longer hospital stays for acute heart failure have lower readmission rates?.
        Circ Heart Fail. 2013; 6: 727-732
        • Fountain D.M.
        • Kolias A.G.
        • Lecky F.E.
        • Bouamra O.
        • Lawrence T.
        • Adams H.
        • et al.
        Survival trends after surgery for acute subdural hematoma in adults over a 20-year period.
        Ann Surg. 2017; 265: 590-596
        • Gardner J.
        • Sexton K.W.
        • Taylor J.
        • Beck W.
        • Kimbrough M.K.
        • Davis B.
        • et al.
        Defining severe traumatic brain injury readmission rates and reasons in a rural state.
        Trauma Surg Acute Care Open. 2018;
        • Knopman J.
        • Link T.W.
        • Navi B.B.
        • Murthy S.B.
        • Merkler A.E.
        • Kamel H.
        Rates of repeated operation for isolated subdural hematoma among older adults.
        JAMA Netw Open. 2018; 1e183737
        • Lee K.-S.
        Chronic subdural hematoma in the aged, trauma or degeneration?.
        J Korean Neurosurg Soc. 2016; 59: 1-5
        • Leroy H.-A.
        • Aboukaïs R.
        • Reyns N.
        • Bourgeois P.
        • Labreuche J.
        • Duhamel A.
        • et al.
        Predictors of functional outcomes and recurrence of chronic subdural hematomas.
        J Clin Neurosci Off J Neurosurg Soc Australas. 2015; 22: 1895-1900
        • Link T.W.
        • Boddu S.
        • Paine S.M.
        • Kamel H.
        • Knopman J.
        Middle meningeal artery embolization for chronic subdural hematoma: a series of 60 cases.
        Neurosurgery. 2018;
        • Lopez Ramos C.
        • Brandel M.G.
        • Rennert R.C.
        • Wali A.R.
        • Steinberg J.A.
        • Santiago-Dieppa D.R.
        • et al.
        Clinical risk factors and postoperative complications associated with unplanned hospital readmissions after cranial neurosurgery.
        World Neurosurg. 2018; 119: e294-e300
        • Lukasiewicz A.M.
        • Grant R.A.
        • Basques B.A.
        • Webb M.L.
        • Samuel A.M.
        • Grauer J.N.
        Patient factors associated with 30-day morbidity, mortality, and length of stay after surgery for subdural hematoma: a study of the American College of Surgeons National Surgical Quality Improvement Program.
        J Neurosurg. 2016; 124: 760-766
        • Marinigh R.
        • Lip G.Y.H.
        • Fiotti N.
        • Giansante C.
        • Lane D.A.
        Age as a risk factor for stroke in atrial fibrillation patients: implications for thromboprophylaxis.
        J Am Coll Cardiol. 2010; 56: 827-837
        • Miranda L.B.
        • Braxton E.
        • Hobbs J.
        • Quigley M.R.
        Chronic subdural hematoma in the elderly: not a benign disease: clinical article.
        J Neurosurg. 2011; 114: 72-76
        • Motiei-Langroudi R.
        • Stippler M.
        • Shi S.
        • et al.
        Factors predicting reoperation of chronic subdural hematoma following primary surgical evacuation.
        J Neurosurg. 2018; 129: 1143-1150
        • Oh H.-J.
        • Lee K.-S.
        • Shim J.-J.
        • Yoon S.-M.
        • Yun I.-G.
        • Bae H.-G.
        Postoperative course and recurrence of chronic subdural hematoma.
        J Korean Neurosurg Soc. 2010; 48: 518-523
        • Qian Z.
        • Yang D.
        • Sun F.
        • Sun Z.
        Risk factors for recurrence of chronic subdural hematoma after burr hole surgery: potential protective role of dexamethasone.
        Br J Neurosurg. 2017; 31: 84-88
        • Schwarz F.
        • Loos F.
        • Dünisch P.
        • Sakr Y.
        • Safatli D.A.
        • Kalff R.
        • et al.
        Risk factors for reoperation after initial burr hole trephination in chronic subdural hematomas.
        Clin Neurol Neurosurg. 2015; 138: 66-71
        • Song D.H.
        • Kim Y.S.
        • Chun H.J.
        • Yi H.J.
        • Bak K.H.
        • Ko Y.
        • et al.
        The Predicting factors for recurrence of chronic subdural hematoma treated with burr hole and drainage.
        Korean J Neurotrauma. 2014; 10: 41-48
        • Thakker A.
        • Briggs N.
        • Maeda A.
        • Byrne J.
        • Davey J.R.
        • Jackson T.D.
        Reducing the rate of post-surgical urinary tract infections in orthopedic patients.
        BMJ Open Qual. 2018;
        • Yang A.I.
        • Balser D.S.
        • Mikheev A.
        • Offen S.
        • Huang J.H.
        • Babb J.
        • et al.
        Cerebral atrophy is associated with development of chronic subdural haematoma.
        Brain Inj. 2012; 26: 1731-1736
        • Zhu W.
        • He W.
        • Guo L.
        • Wang X.
        • Hong K.
        The HAS-BLED score for predicting major bleeding risk in anticoagulated patients with atrial fibrillation: a systematic review and meta-analysis.
        Clin Cardiol. 2015; 38: 555-561