Mortality in Elderly Patients Operated for an Acute Subdural Hematoma : A Surgical Case Series

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Raj , R , Mikkonen , E D , Kivisaari , R , Skrifvars , M B , Korja , M & Siironen , J 2016 , ' Mortality in Elderly Patients Operated for an Acute Subdural Hematoma : A Surgical Case Series ' , World Neurosurgery , vol. 88 , pp. 592-597 . https://doi.org/10.1016/j.wneu.2015.10.095

Title: Mortality in Elderly Patients Operated for an Acute Subdural Hematoma : A Surgical Case Series
Author: Raj, Rahul; Mikkonen, Era D.; Kivisaari, Riku; Skrifvars, Markus B.; Korja, Miikka; Siironen, Jari
Contributor: University of Helsinki, Neurokirurgian yksikkö
University of Helsinki, Clinicum
University of Helsinki, Clinicum
University of Helsinki, Neurokirurgian yksikkö
University of Helsinki, Neurokirurgian yksikkö
Date: 2016-04
Language: eng
Number of pages: 6
Belongs to series: World Neurosurgery
ISSN: 1878-8750
URI: http://hdl.handle.net/10138/223996
Abstract: BACKGROUND: Surgery for elderly patients with acute subdural hematomas (ASDH) is controversial, because postoperative mortality rates are reported to be high and long-term outcomes unknown. Thus, we aimed to describe midterm and long-term mortality rates of elderly patients operated for an ASDH. METHODS: We reviewed all consecutive >= 75-year-old patients operated on for an ASDH between 2009 and 2012. We recorded data on preadmission functional status (independent or dependent) and use of antithrombotic medication. Patients were followed up a median of 4.2 years (range, 2.5-6.4 years). RESULTS: Forty-four patients were included. The majority of the patients (70%) were independent and taking antithrombotic medication (77%). Independent patients had a 1-year mortality of 42%, compared to 69% for dependent patients; 56% of patients taking antithrombotics and 30% of those without antithrombotics died within the first postoperative year. All patients with an admission Glasgow coma scale score of 3-8 died within the first postoperative year, if they used antithrombotics or were dependent before the injury. Of all 1-year survivors, 77% were alive at the end of follow-up. CONCLUSION: In this first surgical case series of 75-year-old or older patients with ASDH, the overall mortality rate appears to be relatively low, especially for preoperatively conscious and independent patients without antithrombotic medication. Patients alive at 1-year after surgery had a life expectancy comparable to their age-matched peers. The prognosis seems to be detrimental for preoperatively unconscious patients who were functionally dependent or used antithrombotic medication before the injury.
Subject: Acute subdural hematoma
Craniotomy
Elderly
Mortality
Prognosis
Prognostic factors
Traumatic brain injury
TRAUMATIC BRAIN-INJURY
HEAD-INJURIES
EPIDEMIOLOGY
COMA
AGE
MANAGEMENT
IMPACT
SCALE
3112 Neurosciences
3126 Surgery, anesthesiology, intensive care, radiology
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