Time to surgery and postoperative functional outcomes among patients with chronic subdural haematomas
Published research co-authored by Mr Gordan Grahovac
This page summarises a peer-reviewed publication co-authored by Mr Gordan Grahovac. The paper examines the relationship between time to surgery and postoperative functional outcomes in patients with symptomatic chronic subdural haematomas.
The aim of this summary is to make the research easier to understand for patients, families and referring clinicians, while linking directly to the original published work.
Research snapshot
Article title: Time to surgery and postoperative functional outcomes among patients with chronic subdural haematomas
Authors: Asfand Baig Mirza, James Knight, Pak Yin Lam, Ariadni Georgiannakis, Amisha Vastani, Feras Fayez, Sami Rashed, Dimitrios Kalaitzoglou, Mustafa El Sheikh, Suzanne Murphy, Nicala Rampersad, Justin Junkai Goh, Afroze Yousaf, Razna Ahmed, Danial Ahmed, Rajan Chand, Rabeeia Parwez, Eranga Goonewardena, Nabila Fadzilah Johani, Paula Corr, Deirdre Nolan, Oktay Genel, Nadia El-Diaz, Christoforos Syrris, Samih Hassan, Mohamed Okasha, Thomas C Booth, Catherine Moran, Samir A Matloob, Taofiq Desmond Sanusi, Arvin Babak, Ahmed-Ramadan Sadek, Babar Vaqas, Gordan Grahovac, Jose Pedro Lavrador
Journal: Journal of Neurology, Neurosurgery & Psychiatry
Publication date: 13 March 2026
Publication details: J Neurol Neurosurg Psychiatry. 2026;97(4):353-359.
PMID: 41605624
PMCID: PMC13018828
DOI: 10.1136/jnnp-2025-337420
Study type: Retrospective multicentre cohort study
Mr Grahovac’s involvement: Listed author on the publication
Original publication: View the original publication on PubMed
What this paper looked at
Chronic subdural haematoma is a common neurological condition. It occurs when blood collects between the brain and one of its outer coverings, often developing gradually over time.
Surgery is often the preferred treatment for symptomatic patients. However, delays can occur for several reasons, including clinical factors, medication-related considerations and hospital logistics.
This publication looked at whether the time between referral and surgery was associated with postoperative functional outcomes in patients with symptomatic chronic subdural haematomas.
The study reviewed patients treated across five UK neurosurgical units within the NHS between 2012 and 2023, with follow-up at one year.
Key points from the publication
The study included 1,015 patients in the final analysis.
Of these patients, 838 had favourable postoperative functional outcomes, while 177 had unfavourable outcomes.
The paper reported that surgical delay was longer in patients with unfavourable outcomes. The average delay was 4.4 days in patients with unfavourable outcomes, compared with 2.9 days in those with favourable outcomes.
The authors found that each additional day of delay was independently associated with poorer postoperative outcomes.
The study also reported that factors linked with delayed time to surgery included older age, antiplatelet medication use, milder neurological presentation and lower frailty scores.
Clinical relevance
This research is relevant to the management of symptomatic chronic subdural haematomas.
For patients who require surgery, the timing of treatment may influence recovery and functional outcome. This study suggests that surgical delay can be associated with poorer outcomes, even when the delay is relatively short.
The findings may help inform how neurosurgical teams prioritise patients, assess surgical timing and manage factors that can contribute to delay, such as medication use or clinical presentation.
What this means in context
This publication does not suggest that every patient with a chronic subdural haematoma requires immediate surgery.
Treatment decisions depend on several factors, including:
The patient’s symptoms
The size and effect of the haematoma
Neurological function
Frailty and general health
Medication use, including antiplatelet or anticoagulant medication
Surgical risk
The urgency of the clinical situation
Research of this kind helps improve understanding of how surgical timing may affect patient outcomes and supports more informed decision-making in neurosurgical care.
View published abstract
The following abstract is reproduced from the original publication and is provided for reference. It may include technical terminology intended for clinical or academic audiences.
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.
View the original publication on PubMed
About Mr Gordan Grahovac
Mr Gordan Grahovac is a Consultant Neurosurgeon and Complex Spinal Surgeon with expertise in managing complex spinal and neurosurgical conditions.
His work includes the assessment and treatment of patients with degenerative spinal conditions, spinal cord compression, spinal tumours, complex spinal pathology and conditions requiring specialist neurosurgical input.
His approach focuses on careful diagnosis, appropriate treatment planning and helping patients understand their options clearly.
Important note
This page is for educational purposes only and should not be taken as individual medical advice.
If you or someone you know has symptoms such as worsening headache, confusion, drowsiness, weakness, changes in speech, seizures, balance problems or symptoms following a head injury, seek urgent medical advice.
