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Frailty Predicts Neurological Outcome in Chronic Subdural Hematoma: A Single-Center Prospective Cohort Study
Tobias Philip Schmidt1, Christian Jacquemain1, Jule Rupprecht1
1Department of Neurosurgery, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University, 52074 Aachen, North Rhine-Westphalia, Germany.
Geriatrics (Basel, Switzerland)
|May 27, 2026
Summary
Preoperative frailty, assessed by the Clinical Frailty Scale (CFS), predicts worse outcomes and higher mortality in patients undergoing surgery for chronic subdural hematoma (cSDH). Frailty assessment aids risk stratification beyond age.
Area of Science:
- Neurosurgery
- Geriatrics
- Clinical Epidemiology
Background:
- Frailty, a state of reduced physiological reserve, is an emerging predictor of postoperative outcomes in neurosurgery.
- Prospective data on frailty in chronic subdural hematoma (cSDH) patients are limited.
- The Clinical Frailty Scale (CFS) is a validated tool for assessing frailty.
Purpose of the Study:
- To investigate the association between preoperative frailty (CFS score ≥ 5) and postoperative recovery in surgically treated cSDH patients.
- To evaluate frailty as a predictor of neurological outcomes and mortality.
- To compare the prognostic value of frailty against age and other clinical factors.
Main Methods:
- Prospective single-center cohort study including 74 surgically treated cSDH patients (≥60 years).
- Frailty assessed using the Clinical Frailty Scale (CFS).
- Primary outcome: Glasgow Outcome Scale-Extended at 6 months (GOSE6). Secondary outcomes: GOSE at discharge and 3 months, revision surgery, ICU admission, and mortality.
Main Results:
- Higher CFS scores significantly correlated with poorer 6-month outcomes (r = -0.68, padj = 0.011).
- Frailty, age, and revision surgery were significant predictors of outcome.
- Frail patients had significantly poorer outcomes at all time points and a substantially higher 6-month mortality rate (32% vs. 4%).
Conclusions:
- Preoperative frailty is strongly associated with poorer neurological recovery and increased mortality after cSDH surgery.
- CFS assessment may improve risk stratification for cSDH patients.
- Frailty evaluation can guide individualized treatment strategies in neurosurgical oncology.
