Beyond the Haematoma: Socioeconomic Deprivation and Outcomes in Chronic Subdural Hematoma in a Single-Centre Cohort Study
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Background
Chronic subdural hematoma (CSDH) is common and increasing in incidence. Short-term post-surgical outcomes are good, but longer term, patients experience increased morbidity and early mortality than controls and the general population. Deprivation and ethnicity affect many health conditions, but to our knowledge, this is the first UK study investigating their association with CSDH outcomes.
Methods
This single-centre retrospective cohort study used Secondary Uses Service Admitted Patient Care Spells (SUS+ APCS) data. Adult subdural hematoma (SDH) patients admitted to St George’s Hospital, London treated with burr-hole surgery between April 2022 and April 2025 were included. Primary outcomes were initial length of stay (LoS) and days spent hospitalised in the subsequent year. Deprivation was measured using Index of Multiple Deprivation (IMD). Linear regression models estimated initial LoS and subsequent days spent hospitalised by category, adjusted for factors including age, ethnicity and comorbidities.
Results
In this single-centre cohort of 449 patients, IMD was not associated with initial LoS, but was significantly associated with subsequent time spent hospitalised. In a log-transformed linear regression model, the most deprived spent 4.5-times longer hospitalised during the year after CSDH than the least deprived (fold change = 4.45, 95% confidence interval (95%CI) 2.20 to 9.01).
Conclusions
Higher neighbourhood-level deprivation was associated with time spent hospitalised following CSDH. This was robust to adjustment for potential mediating factors. This is the first UK study demonstrating health inequalities in CSDH outcomes, highlighting a need for future research to gain further insights, and to improve equity of outcomes after CSDH.
What is already known on this topic?
CSDH is a common sentinel health event, and risk factors include older age, alcohol misuse and taking anticoagulant or antiplatelet medications. Risk factors for poor outcomes include worse pre-morbid functional status and features of more severe CSDH. Neighbourhood-level socioeconomic deprivation is known to be associated with poor health outcomes in many conditions, including fractured neck of femur and stroke.
What this study adds?
This is the first UK study to identify that neighbourhood-level deprivation is associated with poorer outcomes after CSDH. We show that greater deprivation is associated with more days hospitalised during the 12 months after CSDH, indicating that the longer-term negative impacts experienced after CSDH may be exacerbated by neighbourhood-level socioeconomic deprivation.
How this study might affect research, practice or policy
Future research should replicate these analyses in other regions, and investigate the underlying causal factors underling the inequalities in readmission for CSDH patients. Policy should focus on early intervention to mitigate risk factors for readmission, paying particular attention to those in the most deprived populations.
