{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:34:22Z","timestamp":1791261262398,"version":"4.1.0"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2024,4,13]],"date-time":"2024-04-13T00:00:00Z","timestamp":1712966400000},"content-version":"vor","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Addenbrooke\u2019s Charitable Trust","award":["900268"],"award-info":[{"award-number":["900268"]}]},{"name":"Wellcome Trust Clinician PhD Fellowship","award":["220542\/Z\/20\/Z"],"award-info":[{"award-number":["220542\/Z\/20\/Z"]}]},{"DOI":"10.13039\/100006662","name":"NIHR","doi-asserted-by":"publisher","award":["NIHR300696"],"award-info":[{"award-number":["NIHR300696"]}],"id":[{"id":"10.13039\/100006662","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Cambridge NIHR Biomedical Research Centre"},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"name":"TBI-REPORTER Project","award":["MR\/Y008502\/1"],"award-info":[{"award-number":["MR\/Y008502\/1"]}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"name":"UK Ministry of Defence"},{"DOI":"10.13039\/501100002283","name":"Alzheimer\u2019s Research UK","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002283","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design and methods<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>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\u2009=\u200942) and patients (n\u2009=\u2009209) identified that resourcing, communication, and inter-hospital distance posed care challenges. This was corroborated through workshop discussions with stakeholders from two institutions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ageing\/afae076","type":"journal-article","created":{"date-parts":[[2024,4,13]],"date-time":"2024-04-13T01:49:45Z","timestamp":1712972985000},"source":"Crossref","is-referenced-by-count":5,"title":["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"],"prefix":"10.1093","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2778-5226","authenticated-orcid":false,"given":"Daniel James","family":"Stubbs","sequence":"first","affiliation":[{"name":"Division of Anaesthesia, University of Cambridge, Addenbrooke\u2019s Hospital , Hills Road, Cambridge, CB2 0QQ , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam","family":"Khanna","sequence":"additional","affiliation":[{"name":"Department of Perioperative , Acute, Critical, and Emergency Care (PACE), , Hills Road, Cambridge CB2 0QQ , UK"},{"name":"University of Cambridge, Addenbrooke\u2019s Hospital , Acute, Critical, and Emergency Care (PACE), , Hills Road, Cambridge CB2 0QQ , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin M","family":"Davies","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosurgery, University of Cambridge, Addenbrooke\u2019s Hospital , Hills Road, Cambridge CB2 0QQ , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark E","family":"Vivian","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke\u2019s Hospital , Hills Road, Cambridge CB2 0QQ , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Bashford","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke\u2019s Hospital , Hills Road, Cambridge CB2 0QQ , UK"},{"name":"Department of Engineering, Health Systems Design Group , Trumpington Street, Cambridge CB2 1PZ , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krishma","family":"Adatia","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, North West Anglia Foundation Trust, Peterborough City Hospital , Peterborough PE3 9GZ , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Queen Elizabeth Hospital Kings Lynn NHS Foundation Trust , Gayton Road, Kings Lynn, PE30 4ET , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter John","family":"Clarkson","sequence":"additional","affiliation":[{"name":"Department of Engineering, Health Systems Design Group , Trumpington Street, Cambridge CB2 1PZ , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"McGlennan","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia , Bedfordshire Hospital NHS Foundation Trust, , Lewsey Road, Luton, LU4 ODZ , UK"},{"name":"Luton and Dunstable University Hspital , Bedfordshire Hospital NHS Foundation Trust, , Lewsey Road, Luton, LU4 ODZ , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lalani","family":"Indurawage","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, James Paget University Hospitals NHS Foundation Trust , Lowestoft Road, Gorleston-on-Sea, Great Yarmouth NR31 6LA , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martyn","family":"Patel","sequence":"additional","affiliation":[{"name":"Older People\u2019s Medicine Department, Norfolk and Norwich University Hospitals NHS Foundation Trust , Colney Lane, Norwich NR4 7UY , UK"},{"name":"Clinical Associate Professor in Translational and Clinical Medicine , Norwich Medical School, , Norwich , UK"},{"name":"University of East Anglia , Norwich Medical School, , Norwich , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rada","family":"Tyagunenko","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia , Northwest Anglia NHS Foundation Trust, , Parkway Hinchingbrooke, Huntingdon PE29 6NT , UK"},{"name":"Hinchingbrooke Hospital , Northwest Anglia NHS Foundation Trust, , Parkway Hinchingbrooke, Huntingdon PE29 6NT , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rowan","family":"Burnstein","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke\u2019s Hospital , Hills Road, Cambridge CB2 0QQ , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David K","family":"Menon","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Cambridge, Addenbrooke\u2019s Hospital , Hills Road, Cambridge CB2 0QQ , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter J","family":"Hutchinson","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosurgery, University of Cambridge, Addenbrooke\u2019s Hospital , Hills Road, Cambridge CB2 0QQ , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexis","family":"Joannides","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosurgery, University of Cambridge, Addenbrooke\u2019s Hospital , Hills Road, Cambridge CB2 0QQ , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the SENIOR-C team","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,4,12]]},"reference":[{"key":"2024041301491743600_ref1","doi-asserted-by":"crossref","first-page":"2580","DOI":"10.1089\/neu.2020.7574","article-title":"Pathogenesis of chronic subdural haematoma: a cohort evidencing de novo and transformational origins","volume":"38","author":"Edlmann","year":"2021","journal-title":"J Neurotrauma"},{"key":"2024041301491743600_ref2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12974-017-0881-y","article-title":"Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy","volume":"14","author":"Edlmann","year":"2017","journal-title":"J Neuroinflammation"},{"key":"2024041301491743600_ref3","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1016\/j.wneu.2016.07.057","article-title":"Head injury in the elderly: what are the outcomes of neurosurgical care?","volume":"94","author":"Whitehouse","year":"2016","journal-title":"World Neurosurg"},{"key":"2024041301491743600_ref4","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2020-037385","article-title":"Identification of factors associated with morbidity and postoperative length of stay in surgically managed chronic subdural haematoma using electronic health records: a retrospective cohort study","volume":"10","author":"Stubbs","year":"2020","journal-title":"BMJ Open"},{"key":"2024041301491743600_ref5","doi-asserted-by":"crossref","first-page":"732","DOI":"10.3171\/2016.8.JNS16134","article-title":"The management and outcome for patients with chronic subdural hematoma: a prospective, multicenter, observational cohort study in the United Kingdom","volume":"127","author":"Brennan","year":"2016","journal-title":"J Neurosurg"},{"key":"2024041301491743600_ref6","doi-asserted-by":"crossref","first-page":"e166","DOI":"10.1016\/j.wneu.2020.05.060","article-title":"Increases in subdural hematoma with an aging population-the future of American cerebrovascular disease","volume":"141","author":"Neifert","year":"2020","journal-title":"World Neurosurg"},{"key":"2024041301491743600_ref7","doi-asserted-by":"crossref","first-page":"2629","DOI":"10.1007\/s00701-021-04879-z","article-title":"Incidence of chronic subdural haematoma: a single-Centre exploration of the effects of an ageing population with a review of the literature","volume":"163","author":"Stubbs","year":"2021","journal-title":"Acta Neurochir"},{"key":"2024041301491743600_ref8","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1016\/S0140-6736(09)61115-6","article-title":"Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial","volume":"374","author":"Santarius","year":"2009","journal-title":"Lancet"},{"key":"2024041301491743600_ref9","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1007\/s00701-017-3095-2","article-title":"Improved long-term survival with subdural drains following evacuation of chronic subdural haematoma","volume":"159","author":"Guilfoyle","year":"2017","journal-title":"Acta Neurochir"},{"key":"2024041301491743600_ref10","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1080\/02688690701649488","article-title":"A clinical audit of neurosurgical bed usage","volume":"21","author":"Chelvarajah","year":"2007","journal-title":"Br J Neurosurg"},{"key":"2024041301491743600_ref11","volume-title":"European Neurosurgical Centers","author":"European Association of Neurosurgical Societies (EANS). (Brussels, Belgium)"},{"key":"2024041301491743600_ref12","volume-title":"List of Neurocentres. List of Neurocentres in the United Kingdom","author":"Brain and Spine Foundation. (London, UK)"},{"key":"2024041301491743600_ref13","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1111\/anae.15291","article-title":"Guideline for the management of hip fractures 2020: guideline by the Association of Anaesthetists","volume":"76","author":"Griffiths","year":"2021","journal-title":"Anaesthesia"},{"key":"2024041301491743600_ref14","volume-title":"Engineering Better Care: A Systems Approach to Health and Care Design and Continuous Improvement","author":"Clarkson","year":"2017"},{"key":"2024041301491743600_ref15","volume-title":"Proceedings of the IES Conference 2009","author":"Long","year":"2009"},{"key":"2024041301491743600_ref16","doi-asserted-by":"crossref","DOI":"10.1136\/bmjoq-2020-001246","article-title":"Can compliment and complaint data inform the care of individuals with chronic subdural haematoma (cSDH)?","volume":"10","author":"Jones","year":"2021","journal-title":"BMJ Open Quality"},{"key":"2024041301491743600_ref17","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1111\/anae.15583","article-title":"Chronic subdural haematoma: the role of perioperative medicine in a common form of reversible brain injury","volume":"77","author":"Stubbs","year":"2022","journal-title":"Anaesthesia"},{"key":"2024041301491743600_ref18","doi-asserted-by":"crossref","first-page":"e0283958","DOI":"10.1371\/journal.pone.0283958","article-title":"Is information provided within chronic subdural haematoma education resources adequate?","volume":"18","author":"Gillespie","year":"2023","journal-title":"A scoping review PLoS One"},{"key":"2024041301491743600_ref19","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1080\/02688697.2021.2024508","article-title":"Challenges and opportunities in the care of chronic subdural haematoma: perspectives from a multi-disciplinary working group on the need for change","volume":"36","author":"Stubbs","year":"2022","journal-title":"Br J Neurosurg"}],"container-title":["Age and Ageing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ageing\/article-pdf\/53\/4\/afae076\/57221536\/afae076.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ageing\/article-pdf\/53\/4\/afae076\/57221536\/afae076.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,13]],"date-time":"2024-04-13T01:50:09Z","timestamp":1712973009000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ageing\/article\/doi\/10.1093\/ageing\/afae076\/7644530"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,1]]},"references-count":19,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024,4,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ageing\/afae076","relation":{},"ISSN":["0002-0729","1468-2834"],"issn-type":[{"value":"0002-0729","type":"print"},{"value":"1468-2834","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,4,1]]},"published":{"date-parts":[[2024,4,1]]},"article-number":"afae076"}}