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Published on: January 17, 2013
Long-term excess mortality after chronic subdural hematoma
Minna Rauhala1, Pauli Helén2, Karri Seppä3
1Department of Neurosurgery, Tampere University Hospital and Tampere University, Tampere, Finland. minna.j.rauhala@pshp.fi.
Insights
Patients with chronic subdural hematoma (CSDH) face ongoing excess mortality for up to 20 years post-diagnosis. Factors like poor functional status and alcohol abuse significantly increase this risk, with dementia being a leading cause of death.
Area of Science:
- Neurosurgery
- Gerontology
- Public Health
Background:
- Chronic subdural hematoma (CSDH) is a significant neurological condition in older adults.
- Understanding long-term mortality risks and causes of death is crucial for patient management and prognosis.
Purpose of the Study:
- To evaluate the long-term excess mortality associated with chronic subdural hematoma (CSDH).
- To identify specific causes of death and risk factors contributing to increased mortality in CSDH patients.
Main Methods:
- Retrospective analysis of 1133 adult CSDH patients (1990-2015) with follow-up until 2017.
- Comparison of mortality rates and causes of death against a matched general population and control group.
- Estimation of cumulative relative survival ratios and relative excess risks (RER) of death.
Main Results:
- Significant excess mortality observed up to 20 years post-CSDH diagnosis (20-year cumulative excess mortality at 48%).
- Factors associated with increased mortality include poor modified Rankin score, alcohol abuse, warfarin use, advanced age (≥80), non-operative treatment, and non-traumatic etiology.
- Dementia was the most frequent cause of death in CSDH patients (21%) compared to controls (15%).
Conclusions:
- CSDH patients experience persistent excess mortality, influenced by patient-related factors rather than hematoma characteristics.
- There is a notably increased risk of dementia-related mortality among individuals with CSDH.
- Prognosis is strongly linked to pre-existing conditions and functional status at diagnosis and discharge.
Objective:
To assess possible long-term excess mortality and causes of death of patients with chronic subdural hematoma (CSDH).
Methods:
A retrospective study (1990-2015) of adult patients (n = 1133, median age = 76 years old, men = 65%) with CSDH identified by ICD-codes and verified by medical records. All patients were followed until death or the end of 2017. Cumulative relative survival ratios and relative excess risks of death (RER) were estimated by comparing patients' mortality with that in the entire regional matched population. The causes of death were compared with a separate reference group formed by randomly choosing sex, age, and calendar time matched controls (4 controls per each CSDH patient).
Results:
The median follow-up time was 4.8 years (range = 0-27 years), and 710 (63%) of the patients died (median age at death = 84 years old). The cumulative excess mortality was 1 year = 9%, 5 years = 18%, 10 years = 27%, 15 years = 37%, and 20 years = 48%. A subgroup of CSDH patients (n = 206) with no comorbidity had no excess mortality. Excess mortality was related to poor modified Rankin score at admission (RER = 4.93) and at discharge (RER = 8.31), alcohol abuse (RER = 4.47), warfarin (RER = 2.94), age ≥ 80 years old (RER = 1.83), non-operative treatment (RER = 1.56), and non-traumatic etiology (RER = 1.69). Hematoma characteristics or recurrence were unrelated to excess mortality. Dementia was the most common cause of death among the CSDH patients (21%) and the third most common cause in the reference group (15%, p < 0.001).
Conclusions:
Patients with CSDH have continuous excess mortality up to 20 years after diagnosis. Patient-related characteristics have a strong association with excess mortality, whereas specific CSDH-related findings do not. CSDH patients have an increased risk for dementia-related mortality.
