The True Cost of Chronic Subdural Hematoma

Many patients with chronic subdural hematomas are referred to neurosurgeons who generally agree that surgical drainage is warranted. Controversy surrounds the decision as to which drainage method is best because evidence is lacking. Surgeons often therefore select the procedure based on other factors.

Chronic subdural hematomas (CSDH) occur when blood and blood breakdown products accumulate between the brain’s surface and the dura. CSDH usually occurs after a mild head injury, and they are more common in the elderly. Many patients with CSDH are referred to neurosurgeons who generally agree that surgical drainage is warranted. Controversy surrounds the decision as to which drainage method is best because evidence is lacking. Surgeons often therefore select the procedure based on other factors.

Several researchers from institutions around the US address the question of ideal drainage method and cost in a paper published in PLOS One. This retrospective chart review included 119 patients with CSDH who were operated on by 10 neurosurgeons. All patients underwent surgical drainage—58 with craniotomy and 61 with burr hole washout—at a large tertiary care center within a 3-year period. The researchers examined re-operation rates, mortality, morbidity, discharge disability scores, and discharge disposition. Secondary endpoints included length of stay and cost.

The researchers determined that patients who underwent Burr hole washout were in the surgical suite for an average of 79 minutes. They had better outcomes than those who underwent craniotomy. They also had shorter lengths of stay and recurrence rates. Roughly 65% of the burr hole patients were discharged home. The average cost of the procedure alone was $7,588.

Craniotomies occupied the surgical suite for an average of 129 minutes. Approximately 52% of patients treated with craniotomy were discharged home, and they stayed an average of 3 days longer in the hospital than patients in the Burr hole group. The average cost of the procedure alone was $10,716, or $2,828 more than a Burr hole procedure.

Some patients required additional surgical procedures in both study groups, with 6.6% of Burr hole patients and 24.1% of craniotomy patients needing another trip to the surgical suite.

The researchers conclude that Burr hole washout is superior for both patients’ clinical and financial outcome. They acknowledge that prospective long-term multicenter clinical studies would solidify these findings.