A retrospective analysis of surgical outcomes for acute subdural hematoma in an elderly cohort

Background: Acute subdural hematoma (aSDH) in the elderly is an increasingly important public health issue. Mortality rate in this population can be as high as 90% (Copper et al., 1976; Cagetti et al., 1992; Taussky et al., 2012; Hanif, 2009; Raj et al., 2016; Luerssen et al., 1988). Objective: The goal of this study is to examine outcomes for patients 70 years and older who underwent craniotomy for aSDH. Methods: This is a retrospective study of patients 70 years and older who underwent craniotomy for evacuation of aSDH between 2006 and 2016. Patients with subacute, chronic, acute-on-chronic SDH and those considered too neurologically devastated to benefit from surgery were excluded. A multivariable logistic regression was performed to identify independent clinical factors associated with mortality. Results: A total of 1953 elderly patients with SDH were seen between 2006 and 2016. 1325 patients had non-surgical SDH, 307 were too neurologically devastated to benefit from surgery, and 321 elderly patients had surgery. 112 patients had a craniotomy for aSDH. The overall mortality rate was 42%. 24% of patients were discharged to home or a rehabilitation facility. Multivariable logistic regression analysis showed that age, Glasgow Coma Scale (GCS) score, and surgery type had a significant impact on mortality. Conclusion: Elderly patients with aSDH requiring surgery have a high likelihood of mortality. 24% of surgical patients were functional enough to go home or to a rehabilitation facility from the hospital. Age over 80 years old, GCS <9, or cerebral edema significant enough to warrant decompressive craniectomy were associated with an increased risk of death. Keywords: Acute subdural hematoma (aSDH), Long term acute care (LTAC), Rehabilitation facility (rehab), Skilled nursing facility (SNF