Clinical, Laboratory, and Radiological Predictors of Three-Month Outcome After Surgical Treatment of Acute...

Background: Prognostic assessment in patients undergoing surgical treatment for acute extra-axial hematomas remains challenging. Most available prognostic models have been developed in heterogeneous populations of patients with traumatic brain injury, while relatively few studies have focused exclusively on surgically treated patients with acute subdural hematoma (ASDH) and epidural hematoma (EDH). Although mortality has been widely investigated, less attention has been paid to early functional recovery after surgery. This study aimed to identify clinical, physiological, laboratory, and radiological factors associated with early functional outcome three months after surgery in this patient population. Methods: We retrospectively analyzed 181 consecutive patients who underwent surgical treatment for acute extra-axial hematomas at two neurosurgical centers. Demographic, physiological, laboratory, and radiological variables recorded on admission were evaluated. Functional outcome was assessed three months after surgery using the Glasgow Outcome Scale (GOS). Favorable outcome was defined as GOS 4-5 and unfavorable outcome as GOS 1-3. Independent prognostic factors were identified using multivariable logistic regression analysis. Results: An unfavorable outcome was observed in 105 patients (58.0%). Multivariable analysis identified higher admission GCS score as the strongest independent predictor of a favorable functional 3-month outcome (OR = 1.45, 95% CI: 1.27-1.65; p < 0.001). The presence of an epidural hematoma (OR = 5.77, 95% CI: 1.36-24.47; p = 0.018) was also independently associated with a favorable functional outcome. Conversely, traumatic subarachnoid hemorrhage (OR = 0.19, 95% CI: 0.07-0.52; p = 0.001), hyperglycemia (OR = 0.20, 95% CI: 0.05-0.78; p = 0.020), and low hemoglobin levels (reference: normal hemoglobin; OR = 0.18, 95% CI: 0.06-0.54; p = 0.002) were associated with a lower likelihood of favorable functional outcome. Conclusions: Admission neurological status, represented by the GCS score, was the strongest predictor of 3-month functional outcome in patients undergoing surgical treatment for acute extra-axial hematomas. Hematoma type, hemoglobin level, traumatic subarachnoid hemorrhage, and hyperglycemia were also independently associated with outcome. These findings may improve early prognostic assessment; however, because of the retrospective study design and the lack of external validation, they should be interpreted with caution.