Subdural Hematoma in Patients with Hematologic Malignancies: An Outcome Analysis and Examination of Risk Factors of Operative and Nonoperative Management

Christina Huang Wright; James Wright; Andrea Alonso; Alankrita Raghavan; Hasina Momotaz; Christopher Burant; Xiaofei Zhou; Warren Selman; Martha Sajatovic; Alan Hoffer

doi:10.1016/j.wneu.2019.07.079

Subdural Hematoma in Patients with Hematologic Malignancies: An Outcome Analysis and Examination of Risk Factors of Operative and Nonoperative Management

World Neurosurg. 2019 Oct:130:e1061-e1069. doi: 10.1016/j.wneu.2019.07.079. Epub 2019 Jul 16.

Authors

Affiliations

¹ Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. Electronic address: Christina.wright@uhhospitals.org.
² Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
³ Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
⁴ Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA.
⁵ Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, Ohio, USA.
⁶ Department of Neurology and Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.

PMID: 31323408
DOI: 10.1016/j.wneu.2019.07.079

Abstract

Background: Patients with hematologic disorders who present with subdural hematomas (SDH) present a surgical decision-making challenge. Because of intrinsic coagulopathy, platelet dysfunction, and immunosuppression, surgical intervention poses a unique set of risks.

Objective: To describe a clinical sample of patients with hematologic disorders and concurrent SDH, to compare baseline and outcome variables, including complication rates and survival, in surgical versus nonsurgical management, and to identify clinical variables that may predict outcomes.

Methods: A 12-year retrospective case-control study was carried out of 50 adult patients with hematologic malignancies and SDH. Patients underwent surgical evacuation for SDH. Controls did not. Outcomes included discharge disposition, Glasgow Outcome Scale score, 30-day mortality, and overall survival. Complications included seizure, reoperation, and readmission. A Fisher exact test or χ² analysis compared categorical variables; continuous outcomes were compared with a Student t test. A Kaplan-Meier survival analysis was performed and multivariable Cox logistic regression evaluated variables associated with overall mortality.

Results: Surgical and nonsurgical groups differed only by Glasgow Coma Scale score, with slightly lower Glasgow Coma Scale scores in the surgical group. Complication rates did not differ; however, the 30-day reoperation rate was 35% for the surgical cohort. Overall, seizure incidence was 18%, readmission was 30%, 30-day mortality was 38%, median survival was 140.5 days, and 75% had a Glasgow Outcome Scale score of 1-3 at censorship. Increased age, low hemoglobin levels, and low platelet levels were associated with increased risk of mortality.

Conclusions: Low platelet and hemoglobin levels are consistent markers of poor prognosis and surgical intervention, either as a proxy of or as a cause for clinical deterioration, is associated with increased mortality risk.

Keywords: Hematologic malignancy; Myelodysplastic syndrome; Subdural hematoma.

MeSH terms

Adult
Aged
Aged, 80 and over
Case-Control Studies
Disease Management*
Female
Hematologic Neoplasms / diagnosis
Hematologic Neoplasms / epidemiology*
Hematologic Neoplasms / therapy*
Hematoma, Subdural / diagnosis
Hematoma, Subdural / epidemiology*
Hematoma, Subdural / therapy*
Humans
Male
Middle Aged
Retrospective Studies
Risk Factors
Treatment Outcome