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Trauma Mechanisms and Surgical Outcomes in the Elderly Patient with Chronic Subdural Hematoma
Jimmy Sundblom1, Elisabeth Sandberg1,2, Elisabeth Ronne-Engström1
1Department of Medical Sciences, Section of Neurosurgery, Uppsala University Hospital, Uppsala, Sweden.
Insights
Surgery for chronic subdural hematoma in patients over 70 shows good outcomes, with 78.1% improved neurological function. Recurrence rates are similar to the general population, but alcohol use increases complication risks.
Area of Science:
- Neurosurgery
- Geriatrics
- Trauma Care
Background:
- Chronic subdural hematoma (CSH) is a common neurosurgical condition in elderly individuals.
- This study examines surgical outcomes for CSH in patients aged 70 and above.
Purpose of the Study:
- To evaluate the outcomes of surgical intervention for chronic subdural hematoma in patients over 70 years old.
- To identify risk factors for complications and recurrence in this demographic.
Main Methods:
- Retrospective analysis of 511 patients (70-97 years) treated at a single neurosurgical center from 2010-2014.
- Assessment of comorbidities, lifestyle factors, and surgical outcomes including recurrence, mortality, and complications.
Main Results:
- Neurological function improved in 78.1% of patients post-surgery.
- Mortality rate was 3.1%, and recurrence occurred in 9.6% of patients.
- Excessive alcohol use was associated with increased postoperative complications (p=0.02).
Conclusions:
- Fall injuries are the primary cause of CSH in the elderly.
- Recurrence rates in elderly patients are comparable to the general population.
- Excessive alcohol consumption is a significant risk factor for postoperative complications in elderly CSH patients.
Background:
Chronic subdural hematoma is the preeminent neurosurgical condition in the older population. This retrospective single-centre study focuses on outcome after surgery of chronic subdural hematoma in patients over 70 years.
Methods:
Patients treated at a single neurosurgical referral centre between 2010 and 2014 were screened. Included patients were assessed for comorbid conditions, lifestyle factors, and outcomes including recurrence, mortality, and postoperative complications.
Results:
A total of 511 patients (70-97 yrs) were identified. 50.7% of patients were treated with anticoagulants and/or antiplatelet therapy. A known probable cause for the hematoma was found in 68.1% of patient's histories. Mortality rate was 3.1% and recurrence was seen in 49 patients (9.6%). Postoperative complications were more common in patients with excessive use of alcohol (p value = .02). Neurological function was improved in 78.1% of patients after the initial surgery. A strategy of delayed contralateral surgery in bilateral hematomas showed low rates of recurrence.
Conclusion:
Fall injuries are the most common underlying trauma mechanism in the elderly with chronic subdural hematoma. Recurrence is not more common in the elderly patient group compared to the general population. Excessive alcohol use is a risk factor for post-operative complications.
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