Two-day hospital stay surgery for chronic subdural hematoma

Abstract

It is common in Japan that surgical treatment for chronic subdural hematoma (CSDH) requires seven to ten days of hospitalization. The author set out to shorten the required hospitalization period about five years ago. This report shows the safety and fitness of our two-day hospital stay surgery for CSDH. We operated on 210 cases of CSDH in 195 adult patients, 130 males and 65 females with a mean age of 72.7±13.4 years, using one-burr hole and closed-system drainage from April 1997 through September 2001. The drain was removed on the following day of the operation and the patients were discharged on the next day. The stitches were removed at the outpatient office around 7 days after the operation. Mean hospitalization time was 5.3 (2-62) days and a 3-day stay was most common (45.7%). Hospitalization time was from 2 to 4 days in 149 cases (71.0%), from 5 to 9 days in 46 cases (21.9%), and over 10 days in 15 cases (7.1%). The mean hospitalization time of 7.1 days in 36 bilateral CSDHs was longer than that of 5.0 days in 174 unilateral CSDHs. The hospitalization period for patients in a low ADL (activity of daily living) state preoperatively tended to be long. Seven patients had postoperative complications, one died of pancreatitis and another one had acute hydrocephalus. Reoperation was required in 18 cases (9.2%). We had been anxious about the possible overlooking of complications, an increase in reoperations and wound infections. However, the present data showed no such problems. A two-day hospital stay surgery for CSDH is safe and appropriate for shortening a patient's hospitalization requirement.