Age and Salvageability: Analysis of Outcome of Patients Older than 65 Years Undergoing Craniotomy for Acute Traumatic Subdural Hematoma

Taussky, Philipp; Hidalgo, Eveline Teresa; Landolt, Hans; Fandiño, Javier

doi:10.1016/j.wneu.2011.10.030

Cited by 88 publications

(81 citation statements)

References 22 publications

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“…10 This better rate may reflect improvements in medical diagnostics and treatment over the years along with the development of standardized procedures. 2,26 Similar results were shown by Taussky et al, who observed a favorable outcome in 41% of patients with aSDH and an age over 65 years. 26 Interestingly, our results were also comparable to those in previous studies of younger patients with aSDH.…”

Section: Discussionsupporting

confidence: 79%

“…2,26 Similar results were shown by Taussky et al, who observed a favorable outcome in 41% of patients with aSDH and an age over 65 years. 26 Interestingly, our results were also comparable to those in previous studies of younger patients with aSDH. 13,14,18,21 There could be several reasons for this, but first, it is important to consider the definitions of an "elderly" and a "young" patient since these definitions are shifting as life expectancy increases.…”

Section: Discussionsupporting

confidence: 79%

“…In contrast to reports from the 1980s and 1990s with their nearly 90% mortality rates, our rates indicate that functional outcome has improved dramatically over time. 2,26 While the surgical treatment (decompressive craniectomy) of patients over 60 years of age with malignant middle cerebral artery stroke remains controversial because of the substantial postoperative disability (modified Rankin Scale Score 0-2, DESTINY II clinical trial), elderly patients (age ≥ 80 years) with aSDH should be treated given our promising 36% favorable outcome rate at the FU. 10 This better rate may reflect improvements in medical diagnostics and treatment over the years along with the development of standardized procedures.…”

Section: Discussionmentioning

confidence: 99%

“…13,14,18,21 There could be several reasons for this, but first, it is important to consider the definitions of an "elderly" and a "young" patient since these definitions are shifting as life expectancy increases. 26 And besides age, it seems important to look at the comorbidities in elderly patients. In our study, all patients had at least 1 comorbidity, and because of the high number of comorbidities in octo-and nonagenarians, they were treated by an interdisciplinary team.…”

Section: Discussionmentioning

confidence: 99%

“…2,8,14 Over time, improved medical developments and increasing health care resources could have changed the outcomes. 16,26,28 However, elderly patients over 80 years of age with isolated aSDH are rarely mentioned in studies. Indeed, octoand nonagenarians were the scientific "forgotten ones" in the past.…”

mentioning

confidence: 99%

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Significant increase in acute subdural hematoma in octo- and nonagenarians: surgical treatment, functional outcome, and predictors in this patient cohort

Won¹,

Dubinski²,

Brawanski³

et al. 2017

Neurosurgical Focus

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OBJECTIVEAcute subdural hematoma (aSDH) is a common disease increasing in prevalence given the demographic growth of the aging population. Yet, the benefit of surgical treatment for aSDH and the subsequent functional outcome in elderly patients (age ≥ 80 years) remain unclear. Therefore, the aims of this study were to evaluate the incidence of aSDH in patients 80 years or older, determine overall functional outcome, identify predictors of an unfavorable or favorable outcome, and establish specific risk factors for seizures.METHODSThe authors retrospectively analyzed patients 80 years and older who presented with isolated aSDH in the past 10 years at their institution. The following parameters were assessed: baseline characteristics, clinical status on admission and 24 hours after surgery, and clinical course. Functional outcome was assessed at discharge and the 3-month follow-up (FU).RESULTSIn the period from January 2007 to December 2016, 165 patients with aSDH were admitted to the authors’ institution. Sixty-eight patients (41.2%) were 80 years old or older, and the mean age overall was 85 years (range 80–96 years). The incidence of aSDH in the elderly had significantly increased over past decade, with more than 50% of patients admitted to our institution for aSDH now being 80 years or older. The overall mortality rate was 28% at discharge and 48% at the FU. Independent predictors of an unfavorable outcome at discharge were a GCS score ≤ 8 at 24 hours after operation (p < 0.001) and pneumonia (p < 0.02). At the FU, a GCS score ≤ 8 at 24 hours after operation (p < 0.001) and cumulative comorbidities (≥ 5; p < 0.05) were significant independent predictors. All patients with more than 6 comorbidities had died by the FU. Surgical treatment in comatose compared to noncomatose patients had statistically significant, higher mortality rates at discharge and the FU. Still, 23% of the comatose patients and more than 50% of the noncomatose patients had a favorable outcome at the FU (p = 0.06).CONCLUSIONSThe number of octo- and nonagenarians with aSDH significantly increased over the last decade. These patients can achieve a favorable outcome, especially those with a noncomatose status and fewer than 5 comorbidities. Surgical and nonsurgical treatment of octo- and nonagenarians during and after discharge should be optimized to increase clinical improvement.

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