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Updated: Jul 9, 2025
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Predictors of mortality in chronic subdural hematoma evacuation
Rahman Sayed1, Suzanne Gross2, Aroosa Zamarud3
1Department of Neurosurgery, Montefiore Medical Center, Bronx, NY, 10461-1900, USA. rahman.sayed@einsteinmed.edu.
Insights
Altered mental status and failure to extubate are key predictors of postoperative mortality in chronic subdural hematoma (cSDH) patients undergoing evacuation. Age was not a significant factor.
Area of Science:
- Neurosurgery
- Geriatric Medicine
- Critical Care Medicine
Background:
- Chronic subdural hematoma (cSDH) is a frequent intracranial hemorrhage, especially in elderly populations.
- Existing research on predictors for postoperative mortality (POM) in cSDH patients presents conflicting findings.
Purpose of the Study:
- To identify independent predictors of postoperative mortality in patients undergoing chronic subdural hematoma evacuation.
- To analyze the impact of comorbidities, anticoagulation, mental status, laboratory values, and imaging on mortality.
Main Methods:
- Retrospective review of patients undergoing cSDH evacuation from 2015-2022.
- Data collection included comorbidities, anticoagulation, mental status, labs, and imaging.
- Univariate and multivariate analyses were performed to determine mortality predictors.
Main Results:
- Overall in-hospital mortality was 6.1%.
- Univariate analysis indicated higher mortality with dialysis history, altered mental status, intubation, low GCS, Coumadin use, anemia, thrombocytopenia, larger cSDH volume/dimension, and failure to extubate.
- Multivariate analysis identified altered mental status and failure to extubate as independent predictors of mortality.
Conclusions:
- Altered mental status and failure to extubate are significant independent predictors of mortality after cSDH evacuation.
- Patient age was not found to be a significant predictor of mortality in this cohort.
Abstract:
Chronic subdural hematoma (cSDH) is one of the most common types of intracranial hemorrhages, particularly in the elderly. Despite extensive research regarding cSDH diagnosis and treatment, there is conflicting data on predictors of postoperative mortality (POM). We conducted a large retrospective review of patients who underwent a cSDH evacuation at a single urban institution between 2015 and 2022. Data were collected from the electronic medical record on prior comorbidities, anticoagulation use, mental status on presentation, preoperative labs, and preoperative/postoperative imaging parameters. Univariate and multivariate analyses were conducted to analyze predictors of mortality. Mortality during admission for this cohort was 6.1%. Univariate analysis showed the mortality rate was higher in those presenting with a history of dialysis. In addition, those who presented with altered mental status, were intubated, and lower GCS scores had higher rates of POM. Usage of Coumadin was correlated with higher rates of POM. Examination of preoperative labs showed that patients who presented with anemia or thrombocytopenia had higher POM. Imaging data showed that cSDH volume and greatest dimension were correlated with higher rates of POM. Finally, patients that were not extubated postoperatively had higher rates of POM. Multivariate analysis showed that only altered mental status and being not being extubated postoperatively were correlated with a higher risk of mortality. In summation, we demonstrated that altered mental status and failure to extubate were independent predictors or mortality in cSDH evacuation. Interestingly, patient age was not a significant predictor of mortality.
