{
  "abstract": "Background Chronic subdural haematoma (cSDH) is a common neurological condition. Surgery remains the preferred treatment for symptomatic patients. Delays in surgery can occur due to logistical, clinical or medication-related factors. We investigated the relationship between time to surgery and postoperative functional outcomes in symptomatic cSDH.Method Retrospective multicentre cohort study conducted from 2012 to 2023 across five UK neurosurgical units within the National Health Service system, with 1-year follow-up. Of the 1508 patients referred for surgical intervention for cSDH, 1015 remained for analysis. 213 were excluded due to missing data and 280 for ≥30-day wait for surgery to mitigate extreme outliers. Postoperative functional outcome was assessed using the modified Rankin Scale, categorised as ‘favourable’ (0–3) and ‘unfavourable’ (4–6). Predictors of outcome were identified using multivariable logistic regression, and the association between time to surgery and outcome was evaluated by marginal effects analysis. Factors influencing time to surgery were analysed by multivariate linear regression.Results Of 1015 patients, 838 (82.6%) had ‘favourable’ outcomes and 177 (17.4%) had ‘unfavourable’ outcomes. Surgical delay was significantly longer in patients with ‘unfavourable’ outcomes (mean 4.4 vs 2.9 days, p<0.001) and independently associated with poorer outcomes (OR=1.05 per day, p=0.002). Risk increased linearly for each additional day of delay, up to 28% by day 30. Delayed time to surgery included older age (p=0.007), antiplatelet use (p<0.001), high Glasgow Coma Scale Score and Low Frailty Score.Conclusion Surgical delay significantly worsens outcomes in cSDH. Older age, antiplatelet therapy, milder neurological presentation and low frailty scores were key contributors to delay.",
  "authors": [
    {
      "affiliations": [
        "Department of Neurosurgery, Queen’s Hospital, Romford, UK",
        "Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London, UK"
      ],
      "name": "Asfand Baig Mirza"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London, UK"
      ],
      "name": "James Knight"
    },
    {
      "affiliations": [
        "GKT School of Medical Education, King’s College London, London, UK"
      ],
      "name": "Pak Yin Lam"
    },
    {
      "affiliations": [
        "Barts and The London School of Medicine and Dentistry, London, UK"
      ],
      "name": "Ariadni Georgiannakis"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London, UK"
      ],
      "name": "Amisha Vastani"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London, UK"
      ],
      "name": "Feras Fayez"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Queen’s Hospital, Romford, UK"
      ],
      "name": "Sami Rashed"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London, UK"
      ],
      "name": "Dimitrios Kalaitzoglou"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Queen Elizabeth University Hospital, Glasgow, UK"
      ],
      "name": "Mustafa El Sheikh"
    },
    {
      "affiliations": [
        "Beaumont Hospital, Dublin, Leinster, Ireland"
      ],
      "name": "Suzanne Murphy"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Queen’s Hospital, Romford, UK"
      ],
      "name": "Nicala Rampersad"
    },
    {
      "affiliations": [
        "GKT School of Medical Education, King’s College London, London, UK"
      ],
      "name": "Justin Junkai Goh"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London, UK"
      ],
      "name": "Afroze Yousaf"
    },
    {
      "affiliations": [
        "GKT School of Medical Education, King’s College London, London, UK"
      ],
      "name": "Razna Ahmed"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Queen’s Hospital, Romford, UK"
      ],
      "name": "Danial Ahmed"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Queen’s Hospital, Romford, UK"
      ],
      "name": "Rajan Chand"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Queen’s Hospital, Romford, UK"
      ],
      "name": "Rabeeia Parwez"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Queen Elizabeth University Hospital, Glasgow, UK"
      ],
      "name": "Eranga Goonewardena"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Queen Elizabeth University Hospital, Glasgow, UK"
      ],
      "name": "Nabila Fadzilah Johani"
    },
    {
      "affiliations": [
        "Beaumont Hospital, Dublin, Leinster, Ireland"
      ],
      "name": "Paula Corr"
    },
    {
      "affiliations": [
        "Beaumont Hospital, Dublin, Leinster, Ireland"
      ],
      "name": "Deirdre Nolan"
    },
    {
      "affiliations": [
        "GKT School of Medical Education, King’s College London, London, UK"
      ],
      "name": "Oktay Genel"
    },
    {
      "affiliations": [
        "West Middlesex University Hospital, London, UK"
      ],
      "name": "Nadia El-Diaz"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London, UK"
      ],
      "name": "Christoforos Syrris"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Queen Elizabeth University Hospital, Glasgow, UK"
      ],
      "name": "Samih Hassan"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Ninewells Hospital and Medical School, Dundee, UK"
      ],
      "name": "Mohamed Okasha"
    },
    {
      "affiliations": [
        "King’s College London, London, UK"
      ],
      "name": "Thomas C Booth"
    },
    {
      "affiliations": [
        "Beaumont Hospital, Dublin, Leinster, Ireland"
      ],
      "name": "Catherine Moran"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"
      ],
      "name": "Samir A Matloob"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Queen’s Hospital, Romford, UK"
      ],
      "name": "Taofiq Desmond Sanusi"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Queen’s Hospital, Romford, UK"
      ],
      "name": "Arvin Babak"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Queen’s Hospital, Romford, UK"
      ],
      "name": "Ahmed-Ramadan Sadek"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Queen’s Hospital, Romford, UK"
      ],
      "name": "Babar Vaqas"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London, UK"
      ],
      "name": "Gordan Grahovac"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London, UK"
      ],
      "name": "Jose Pedro Lavrador"
    }
  ],
  "title": "Time to surgery and postoperative functional outcomes among patients with chronic subdural haematomas",
  "uid": "093ec63c-3976-5812-bc30-b868904077c4"
}