Long-Term Mortality, Cognition, and Quality of Life After Chronic Subdural Hematoma Surgery

Chronic subdural hematoma (cSDH) is among the most common neurosurgical disorders in older adults. Although short-term outcomes after surgery are favorable, long-term survival and health-related quality of life (HRQoL) remain poorly characterized.

To evaluate long-term survival, excess mortality, and HRQoL 10 years after surgical treatment of cSDH.

This population-matched cohort study was conducted at a single tertiary referral center in Switzerland, with mortality follow-up through December 31, 2023 (mean [SD] follow-up, 9.55 [1.24] years), and cross-sectional HRQoL assessment through December 31, 2024 (mean [SD] follow-up, 10.05 [1.16] years). Analyses were conducted from October to December 2025. Adults surgically treated for cSDH between June 2012 and August 2016 were included, matched with the Swiss general population by age, sex, and birth month for mortality analysis. Among survivors, those completing HRQoL assessment were compared with age- and sex-weighted European reference values.

Surgically treated cSDH.

The primary outcome was all-cause mortality, estimated using Kaplan-Meier analysis, with excess mortality expressed as absolute survival differences and standardized mortality ratios (SMRs). Secondary outcomes were the following HRQoL domains: cognitive functioning (CF), physical functioning (PF), role functioning (RF), emotional functioning (EF), social functioning (SF), and global QoL, compared using 2-sided z tests.

A total of 359 adults surgically treated for cSDH were included; among survivors, 147 completed HRQoL assessment and were compared with age- and sex-weighted European reference values. Among 359 patients (mean [SD] age, 73.4 [11.0] years; 117 female patients [32.6%]), overall survival was significantly lower than matched controls (hazard ratio [cohort vs control], 2.02; 95% CI, 1.73-2.37; log-rank P < .001). One-year survival in the cSDH cohort was 92.8% (95% CI, 90.1%-95.5%) vs 98.8% (95% CI, 98.7%-98.8%) in controls, representing an excess mortality of 6.0 percentage points (SMR, 3.22; 95% CI, 2.10-4.72); 5-year survival was 76.6% (95% CI, 72.3%-81.1%) vs 88.2% (95% CI, 88.2%-88.3%), representing an excess of 11.6 percentage points (SMR, 1.19; 95% CI, 0.95-1.47); and 10-year survival was 55.5% (95% CI, 50.3%-61.3%) vs 73.5% (95% CI, 73.4%-73.6%), representing an excess of 18.0 percentage points (SMR, 1.12; 95% CI, 0.94-1.31). Men reported significantly lower mean (SD) PF scores (75.9 [26.8] vs control mean score, 83.22; P < .001), RF scores (74.9 [32.0] vs 84.87; P < .001), CF scores (77.6 [22.6] vs 87.38; P < .001), and SF scores (84.3 [24.0] vs 90.00; P = .02) than controls, and women reported lower mean (SD) RF (69.0 [30.9] vs 80.91; P = .02) and CF scores (70.2 [24.8] vs 86.50; P < .001). EF and global QoL did not differ significantly from European reference values.

In this population-matched cohort study, patients surgically treated for cSDH experienced sustained excess mortality and clinically relevant HRQoL deficits 10 years after surgery. These findings call for structured postoperative and rehabilitative care beyond the acute phase.