Medical Student University of Florida College of Medicine
Introduction: There is limited evidence regarding factors that influence outcomes of elderly patients that require surgical evacuation of acute subdural hematoma (aSDH). Poor outcomes following evacuation have put into question the true risks and benefits of surgery. This study aims to identify predictors of adverse clinical outcomes in patients 60 years old and greater following the evacuation of acute SDH.
Methods: A retrospective review of patients 60 years old and greater who had surgical evacuation of aSDH between 2013-2021 at a single Level I trauma center was performed. In-hospital mortality and functional neurological recovery at the last documented follow-up were utilized as primary endpoints. Clinical parameters were analyzed using descriptive statistics, and simple, and multivariate logistic regression analysis.
Results: A total of 100 patients were identified. The median age was 77 years and 64% were male. Mechanism of injury was traumatic in 82% of patients. Compared to their baseline, 63% of patients showed improvement, while 37% of patients developed a complication after surgery. In-hospital mortality was 11%. The median duration of follow-up was 293 days. Age (Odds-Ratio [OR]: 0.897; 95%-confidence-interval [CI]: 0.822-0.978, P=0.014) and SDH size (OR: 0.897; 95%-CI: 0.814-0.987, P=0.026) on admission were associated with decreased odds of functional neurological recovery at last follow-up. After adjusting for age and sex, Clinical frailty scale scores (adjusted-odds-ratio [aOR]: 1.92; 95%-CI: 1.001-3.683, P=0.050) and history of tobacco smoke (aOR: 8.935; 95%-CI: 1.846-43.258, P=0.006) were predictors of death during admission.
Conclusion : We demonstrate that SDH size, frailty, and tobacco use history may be utilized as additional prognostic tools to better predict negative outcomes of elderly patients following surgery for aSDH. Clinicians should consider screening for and utilizing these parameters to better inform clinical risk stratification and counsel patients and their families.
