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Mortality and causes of death after surgery for chronic subdural hematoma: a post hoc study of the FINISH randomized
Pihla Tommiska1, Oula Knuutinen2, Kimmo Lönnrot3
1Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, Po Box 320, 00029 HUS, Helsinki, Finland. pihla.tommiska@helsinki.fi.
Insights
Mortality after chronic subdural hematoma (CSDH) surgery is 14%, with circulatory diseases, accidents, and dementia as leading causes. Pre-existing conditions significantly increase death risk in elderly CSDH patients.
Area of Science:
- Neurosurgery
- Geriatric Medicine
- Public Health
Background:
- Chronic subdural hematoma (CSDH) is a prevalent neurosurgical condition, particularly in the elderly, impacting life expectancy.
- The FINISH trial (NCT04203550) is a completed national, multicenter, randomized study conducted in Finland.
Purpose of the Study:
- To investigate mortality rates and causes of death following burr-hole drainage surgery for CSDH.
- To identify risk factors associated with mortality in CSDH patients undergoing surgery.
Main Methods:
- Analysis of patient data from the FINISH trial (n=589).
- Mortality data obtained from Statistics Finland.
- Causes of death classified using the European shortlist (ICD-10).
Main Results:
- 14% (82/589) of patients died after a median follow-up of 16.4 months.
- Leading causes of death: circulatory diseases (34%), accidents (16%), and dementia (15%).
- Pre-existing comorbidities, including dementia, cardiac arrhythmia, cerebrovascular events, and hypertension, were significant risk factors for mortality.
Conclusions:
- CSDH surgery patients face significant mortality, influenced by pre-existing conditions.
- Understanding these comorbidities is crucial for improving patient outcomes after CSDH surgery.
Purpose:
Chronic subdural hematoma (CSDH) is a common neurosurgical disease, especially prevalent among the elderly and is associated with reduced life expectancy. This study investigated mortality and causes of death after burr-hole drainage surgery for CSDH.
Methods:
We included patients from the FINISH trial, a national, multicenter, randomized study conducted in Finland during 2020-2022. We obtained mortality data from Statistics Finland. For the classification of causes of death, we used the European shortlist of 86 causes, which is derived from the 10th revision of the International Classification of Diseases and Related Health Problems (ICD-10).
Results:
Overall, the FINISH trial population included 589 patients (median age 78 years, 28% women). After a median follow-up of 16.4 months (IQR 9.7-23.1), 82 patients (14%) died. The median age at death was 85 years (IQR 81-89), and the median time from surgery to death was 6.5 months (IQR 2.4-15.3). The leading causes of death were circulatory diseases (34%), accidents (16%), and dementia (15%). A higher number of pre-existing comorbidities was significantly associated with increased mortality. In particular, dementia, cardiac arrhythmia, prior cerebrovascular events, and hypertension emerged as significant risk factors for death.
Conclusion:
This study provides valuable insights into mortality rates and causes of death among patients undergoing CSDH surgery. The findings underscore the critical role of pre-existing comorbidities in influencing patient outcomes.
Trial Registration:
The FINISH trial was registered with ClinicalTrials.gov (NCT04203550) on Dec 16, 2019. The trial is completed.
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