前額皮切による慢性硬膜下血腫の１泊２日クリニカルパス導入の有用性

抄録

Background: Chronic subdural hematoma (CSDH) is a benign entity and can be treated surgically in most cases. In recent years, the number of patients has been increasing with the aging population and appropriate treatment is required in terms of health economics.

Materials and Methods: In 2007 a clinical pathway (CP) for surgical treatment of CSDH was developed in our department. Most of the patients underwent craniostomy and drainage of hematoma via small skin incision on the forehead without hair removal on the day of admission, and were discharged the next day with a small adhesive plaster over the operative scar. Sixty-one CSDH patients were admitted to our department between 2007 and 2011. Fifty-one patients were included in the CP while the remaining 10 patients were excluded for various reasons, including bad general and/or neurological conditions, inconvenience in revisits to the hospital from a remote place, and family's dissent. In 15 patients out of the 51 included patients, variances in clinical pathway were observed due to surgical and/or systemic complications, delayed recovery of ADL, or family refusal of discharge.

Results: Most of the patients showed quick recovery after surgery, except for a patient in the excluded group who suffered a femoral fracture as a complication from delirium and wandering on Day 12, which resulted in poor outcome. Recurrence occurred in 3 of the 61 patients (4.9%), which compares favorably with previous reports. The mean number of hospitalization days was 7.1. It was significantly shorter than that of 53 patients treated between 2001 and 2006 before CP had been developed.

Conclusion: Reduction of hospital stay after the implementation of CP was achieved without deterioration in quality of medical care. Shorter hospital stay may possibly reduce major complications due to dementia.