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Long-term postoperative prognosis and associated risk factors of chronic subdural hematoma in the elderly

Shohei Kinoshita1, Hiroki Ohkuma2, Nozomi Fujiwara1

  • 1Department of Neurosurgery, Hirosaki University Hospital, Hirosaki, Aomori, Japan.

Clinical Neurology and Neurosurgery
|June 27, 2024
PubMed

Insights

Elderly patients with chronic subdural hematoma (CSDH) face poorer surgical outcomes. High age and reduced activities of daily living (ADL) at discharge are key risk factors for poor prognosis in these patients.

Area of Science:

  • Neurosurgery
  • Geriatric Medicine
  • Clinical Outcomes Research

Background:

  • Surgical treatment for chronic subdural hematoma (CSDH) generally yields good outcomes.
  • However, recent evidence suggests suboptimal surgical results for elderly CSDH patients.
  • This study investigates prognostic factors specifically in the elderly CSDH population.

Purpose of the Study:

  • To analyze the prognosis of elderly patients undergoing surgical treatment for chronic subdural hematoma (CSDH).
  • To identify clinical characteristics associated with poor outcomes in this demographic.
  • To inform strategies for improving surgical results in older adults with CSDH.

Main Methods:

  • Retrospective analysis of 232 CSDH patients from three hospitals.
  • Data collected included age, sex, comorbidities, medications, radiological findings, and modified Rankin Scale (mRS) scores.
  • Poor prognosis defined as mRS aggravation or mRS ≥ 3 at follow-up examination.

Main Results:

  • Age ≥ 75 years was a significant prognostic factor for poor outcome (p=0.0002).
  • In elderly patients, discharge mRS (p=0.0184) and postoperative medical complications (p<0.0001) were significant risk factors.
  • High age and activities of daily living (ADL) at discharge were significant predictors of poor CSDH prognosis.

Conclusions:

  • Advanced age and lower ADL at discharge are critical prognostic factors for CSDH in the elderly.
  • Improving ADL, managing postoperative complications, and implementing rehabilitation are crucial for better outcomes.
  • Targeted interventions can enhance the prognosis for elderly CSDH patients.

Keywords:
AgeChronic subdural hematomaModified Rankin Scale score at dischargePostoperative systemic complications

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