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Chronic subdural haematoma: the role of peri-operative medicine in a common form of reversible brain injury.

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cam.depositDate2022-01-11
cam.issuedOnline2022-01-10
cam.orpheus.success2022-01-13 - Embargo set during processing via Fast-track
dc.contributor.authorStubbs, DJ
dc.contributor.authorDavies, BM
dc.contributor.authorMenon, DK
dc.contributor.orcidStubbs, DJ [0000-0003-2778-5226]
dc.contributor.orcidDavies, BM [0000-0003-0591-5069]
dc.contributor.orcidMenon, DK [0000-0002-3228-9692]
dc.date.accessioned2022-01-14T00:30:21Z
dc.date.available2022-01-14T00:30:21Z
dc.date.issued2022-01
dc.date.updated2022-01-11T22:08:58Z
dc.description.abstractEpidemiological studies project a significant rise in cases of chronic subdural haematoma over the next 20 years. Patients with this condition are frequently older and medically complex, with baseline characteristics that may increase peri-operative risk. The intra-operative period is only a small portion of a patient's total hospital stay, with a majority of patients in the United Kingdom transferred between institutions for their surgical and rehabilitative care. Definitive management remains surgical, but peri-operative challenges exist which resonate with other surgical cohorts where multidisciplinary working has become the gold standard. These include shared decision-making, medical optimisation, the management of peri-operative anticoagulation and the identification of key points of equipoise for examination in the future trials. In this narrative review, we use a stereotyped patient journey to provide context to the recent literature, highlighting where multidisciplinary expertise may be required to optimise patient care and maximise the benefits of surgical management. We discuss the triage, pre-operative optimisation, intra-operative management and immediate postoperative care of patients undergoing surgery for a chronic subdural haematoma. We also discuss where adjunctive medical management may be indicated. In so doing, we present the current and emerging evidence base for the role of an integrated peri-operative medicine team in the care of patients with a chronic subdural haematoma.
dc.identifier.doi10.17863/CAM.80133
dc.identifier.eissn1365-2044
dc.identifier.issn0003-2409
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/332689
dc.language.isoeng
dc.publisherWiley
dc.publisher.urlhttp://dx.doi.org/10.1111/anae.15583
dc.rightsAttribution 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectanaesthesia
dc.subjectchronic subdural haematoma
dc.subjectneurosurgery
dc.subjectperi-operative medicine
dc.subjectreview
dc.subjectAnti-Inflammatory Agents
dc.subjectBrain Injuries
dc.subjectFibrinolytic Agents
dc.subjectHematoma, Subdural, Chronic
dc.subjectHumans
dc.subjectPerioperative Care
dc.subjectPostoperative Care
dc.titleChronic subdural haematoma: the role of peri-operative medicine in a common form of reversible brain injury.
dc.typeArticle
dcterms.dateAccepted2021-08-02
prism.endingPage33
prism.issueIdentifierS1
prism.publicationDate2022
prism.publicationNameAnaesthesia
prism.startingPage21
prism.volume77
pubs.funder-project-idWellcome Trust (204017/Z/16/Z)
pubs.licence-display-nameApollo Repository Deposit Licence Agreement
pubs.licence-identifierapollo-deposit-licence-2-1
rioxxterms.typeJournal Article/Review
rioxxterms.versionAM
rioxxterms.versionofrecord10.1111/anae.15583

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