Challenges and patient outcomes in chronic subdural haematoma at the level of a regional care system: A multi-centre, mixed-methods study from the East of England

Stubbs, Daniel James, Khanna, Sam, Davies, Benjamin M., Vivian, Mark E., Bashford, Tom, Adatia, Krishma, Chen, Ping, Clarkson, Peter John, McGlennan, Catherine, Indurawage, Lalani, Patel, Martyn, Tyagunenko, Rada, Burnstein, Rowan, Menon, David K., Hutchinson, Peter J. and Joannides, Alexis and SENIOR-C team (2024) Challenges and patient outcomes in chronic subdural haematoma at the level of a regional care system: A multi-centre, mixed-methods study from the East of England. Age and Ageing, 53 (4). ISSN 0002-0729

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Background: Chronic subdural haematoma (cSDH) is a common neurosurgical pathology affecting older patients with other health conditions. A significant proportion (up-to 90%) of referrals for surgery in neurosciences units (NSU) come from secondary care. However, the organisation of this care and the experience of patients repatriated to non-specialist centres are currently unclear. Objectives: This study aimed to clarify patient outcome in non-specialist centres following NSU discharge for cSDH surgery and to understand key system challenges. The study was set within a representative neurosurgical care system in the east of England. Design and methods: We performed a retrospective cohort analysis of patients referred for cSDH surgery. Alongside case record review, patient and staff experience were explored using surveys as well as an interactive c-design workshop. Challenges were identified from thematic analysis of survey responses and triangulated by focussed workshop discussions. Results: Data on 381 patients referred for cSDH surgery from six centres was reviewed. One hundred and fifty-six (41%) patients were repatriated following surgery. Sixty-one (39%) of those repatriated suffered an inpatient complication (new infection, troponin rise or renal injury) following NSU discharge, with 58 requiring institutional discharge or new care. Surveys for staff (n = 42) and patients (n = 209) identified that resourcing, communication, and inter-hospital distance posed care challenges. This was corroborated through workshop discussions with stakeholders from two institutions. Conclusions: A significant amount of perioperative care for cSDH is delivered outside of specialist centres. Future improvement initiatives must recognise the system-wide nature of delivery and the challenges such an arrangement presents.

Item Type: Article
Additional Information: Funding Information: This project was funded by the Addenbrooke’s Charitable Trust (#900268). DJS was funded by a Wellcome Trust Clinician PhD Fellowship (220542/Z/20/Z) while conducting this work. BMD is supported by an NIHR doctoral research fellowship (NIHR300696). This work was supported by the Cambridge NIHR Biomedical Research Centre (BRC). The views expressed here are those of the authors and not those of the NIHR or department of health. As this work was funded in whole or in part by the Wellcome Trust a CC-BY licence is applied to the author accepted manuscript (AAM) of this publication in keeping with the grant’s open access requirements. DKM and PJAH are supported by the TBI-REPORTER Project (Grant No: MR/Y008502/1), which is supported by a multi-funder consortium consisting of: Medical Research Council, UK; National Institute for Health and Care Research; UK Ministry of Defence, and Alzheimer’s Research UK. Funders had no role in the design, execution, analysis and interpretation of data or writing of the study.
Uncontrolled Keywords: care systems,chronic subdural haematoma,epidemiology,older people,perioperative medicine,geriatrics and gerontology,ageing ,/dk/atira/pure/subjectarea/asjc/2700/2717
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups: Faculty of Medicine and Health Sciences > Research Centres > Lifespan Health
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Depositing User: LivePure Connector
Date Deposited: 07 Jun 2024 16:30
Last Modified: 13 Jun 2024 16:30
DOI: 10.1093/ageing/afae076


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