Mortality and Functional Outcome in Surgically Evacuated Acute Subdural Hematoma in Elderly Patients

Significant morbidity and mortality is associated with surgical evacuation of acute subdural hematomas (ASDHs) in the elderly population. The literature remains mixed on risk factors associated with poor outcomes, specifically preoperative antithrombotic usage and postoperative seizures.

Between January 1, 2013, and December 31, 2017, we retrospectively identified 62 patients ≥65 years of age who underwent a craniotomy for evacuation of an ASDH, with the primary outcome being Glasgow Outcome Scale (GOS) score at discharge and 3- and 6-month follow-up.

Of the patients, 52% were women, with a median age of 78 years (range, 65-93 years). The mechanism of injury was because of a fall in 40 patients. Twenty-eight patients (44%) had a poor outcome (GOS score 1-2) at discharge, increasing to 31 patients (50%) at 3-month follow-up. Eight patients (13%) had a good outcome (GOS score 4-5) at discharge, increasing to 17 patients (27%) at 3-month follow-up. Perioperative mortality rate was 39%, increasing to 44% at 3-month follow-up. The strongest associations with mortality in descending order were 24-hour postoperative Glasgow Come Scale (GCS) score, midline shift, preoperative GCS score, and pupillary abnormalities. Although age was not a statistically significant factor for mortality, patients with a favorable outcome (GOS score 4-5) had a median age of 71 years versus 78 years for GOS score 1-3. Preoperative antithrombotic usage and postoperative seizures were not significant predictors of outcome or mortality.

A high percentage of morbidity and mortality remains in the management of ASDHs in the elderly population; however, a significant percentage (27%) can still go on to have a favorable outcome.