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Updated: Sep 25, 2025
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Prognosis of patients with operated chronic subdural hematoma
Jussi P Posti1, Teemu M Luoto2, Jussi O T Sipilä3,4
1Neurocenter, Department of Neurosurgery and Turku Brain Injury Center, Turku University Hospital and University of Turku, P.O. Box 52, 20521, Turku, Finland. jussi.posti@utu.fi.
Insights
Chronic subdural hematoma (cSDH) is more dangerous than previously thought, with significant mortality and reoperation rates. Patient factors like age and comorbidities impact outcomes, necessitating careful management.
Area of Science:
- Neurosurgery
- Geriatric Medicine
- Public Health
Background:
- Chronic subdural hematoma (cSDH) was historically considered a low-risk condition.
- Emerging evidence suggests cSDH may indicate underlying clinical decline.
- Understanding cSDH outcomes is crucial for patient care and resource allocation.
Purpose of the Study:
- To investigate case-fatality, excess mortality, and reoperation rates in operated cSDH patients.
- To identify patient-related characteristics associated with adverse outcomes.
- To analyze trends in cSDH outcomes over time.
Main Methods:
- Retrospective analysis of Finnish nationwide databases (2004-2017).
- Inclusion of adult patients (≥16 years) with evacuated cSDH.
- Follow-up for mortality and reoperation data.
Main Results:
- 8539 patients with cSDH; 45% died during follow-up.
- 1-year case-fatality rates were 14.3% (men) and 15.3% (women).
- Comorbidities, older age, and alcoholism predicted fatality; older age predicted reoperation.
Conclusions:
- cSDH poses a significant mortality risk, particularly in older patients and those with comorbidities.
- Reoperation rates are substantial, influenced primarily by patient age.
- The perception of cSDH as benign is outdated; comprehensive management is essential.
Abstract:
Chronic subdural hematoma (cSDH), previously considered fairly benign and easy to treat, is now viewed a possible sign of incipient clinical decline. We investigated case-fatality, excess fatality and need for reoperations following operated cSDH in a nationwide setting focusing on patient-related characteristics. Finnish nationwide databases were searched for all admissions with operated cSDH as well as later deaths in adults (≥ 16 years) during 2004-2017. There were 8539 patients with an evacuated cSDH (68% men) with a mean age of 73.0 (± 12.8) years. During the follow-up, 3805 (45%) patients died. In-hospital case-fatality was 0.7% (n = 60) and 30-day case-fatality 4.2% (n = 358). The 1-year case-fatality was 14.3% (95% CI = 13.4-15.2%) among men and 15.3% (95% CI = 14.0-16.7%) among women. Comorbidity burden, older age, and alcoholism were significantly associated with fatality. One-year excess fatality rate compared to general Finnish population was 9.1% (95% CI = 8.4-9.9) among men and 10.3% (95% CI = 9.1-11.4) among women. Highest excess fatality was observed in the oldest age group in both genders. Reoperation was needed in 19.4% (n = 1588) of patients. Older age but not comorbidity burden or other patient-related characteristics were associated with increased risk for reoperation. The overall case-fatality and need for reoperations declined during the study era. Comorbidities should be considered when care and follow-up are planned in patients with cSDH. Our findings underpin the perception that the disease is more dangerous than previously thought and causes mortality in all exposed age groups: even a minor burden of comorbidities can be fatal in the post-operative period.
