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

Raj, Rahul; Mikkonen, Era D.; Kivisaari, Riku; Skrifvars, Markus B.; Korja, Miikka; Siironen, Jari

doi:10.1016/j.wneu.2015.10.095

Cited by 52 publications

(45 citation statements)

References 21 publications

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“…The incidence of seizures in patients with aSDH is between 24% and 36% and has been shown to be related to poor functional and social outcomes. 9,17,[20][21][22] Despite a decreasing risk of developing seizures and epilepsy over time, the risk persists for up to 10 years, which could be one explanation for the negative influence on long-term functional outcome. 4 Predictors of seizures in elderly patients were a low GCS score 24 hours after operation and a left-sided hematoma, similar to the previously published results by Rabinstein et al 21 Since elderly patients with comorbidities have clinical fluctuation more often than younger patients, the diagnosis of seizure may …”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

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

View full text Add to dashboard Cite

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“…The 75% unfavourable outcome rate (64% mortality) in our study is similar to most previously published series (Table 5). 2,4,5,[10][11][12][13][14][15][16][17][18][19][20] The high percentage of favourable outcome and concomitant low 2 (13) a 1 missing. aSDH: acute subdural hematoma, hrs: hours, GCS: Glasgow Coma Scale score, GOS: Glasgow Outcome Scale score, IQR: interquartile range, n: number of patients, saSDH: subacute subdural hematoma, SD: standard deviation.…”

Section: Literature Reviewmentioning

confidence: 99%

Do older patients with acute or subacute subdural hematoma benefit from surgery?

Bus

Verbaan

Kerklaan

et al. 2018

British Journal of Neurosurgery

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Purpose: According to the international guidelines, acute subdural hematomas (aSDH) with a thickness of >10 mm, or causing a midline shift of >5 mm, should be surgically evacuated. However, high mortality rates in older patients resulted in ongoing controversy whether elderly patients benefit from surgery. We identified predictors of outcome in a single-centre cohort of elderly patients undergoing surgical evacuation of aSDH or subacute subdural hematoma (saSDH). Materials and methods: This retrospective study included all patients aged !65 years undergoing surgical evacuation of aSDH/saSDH from 2000 to 2015. One-year outcome was dichotomized into favourable (Glasgow Outcome Scale (GOS) 4-5) and unfavourable (GOS 1-3). Predictors of outcome were identified by analysing patient characteristics. Results: Eighty-four patients aged !65 years underwent craniotomy for aSDH/saSDH during the 16 year time period. Twenty-five percent regained functional independence, 11% survived severely disabled, and 64% died. Most patients died of respiratory failure following withdrawal of artificial respiration or following restriction of treatment. Age of the SDH or Glasgow Coma Scores 8/intubation did not predict unfavourable outcome. All patients with bilaterally absent pupillary light reflexes died, also those who still exhibited one normal-sized pupil. Conclusion: The low number of operated patients per year probably suggests that this cohort represents a selection of patients who were judged to have good chances of favouring from surgery. Functional independence at one-year follow-up was reached in 25% of patients, 64% died. Patients with bilaterally absent pupillary light reflexes did not benefit from surgery. The tendency to restrict treatment because of presumed poor prognosis may have acted as a self-fulfilling prophecy.

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“…31,40 Careful patient selection, good pre-injury health status and and aggressive treatment for such pateints have been associated with lower short-term mortality among the elderly. 18,41,42 There are no evidence-based national or international consensus guidelines and management guidelines for acute inpatient management or long-term outpatient follow-up of older adults with TBI. This is, in large part, attributed to the paucity of dedicated Class I prospective clinical trials of treatments for older adults withTBI.…”

Section: Discussionmentioning

confidence: 99%

Geriatric head injuries: impact and outcomes

et al. 2019

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Background: Elderly trauma patients present unique challenges and face more significant obstacles in recovery than their younger counterparts. They usually experience higher morbidity and mortality and slower recovery trajectories and have, on average, worse functional, cognitive, and psychosocial outcomes months or years post-injury than do younger patients.Methods: Authors conducted a study of elderly head injury patients to understand the epidemiology of geriatric TBI, the impact of comorbidities and management issues and outcomes in such patients. Authors had a total of 110 patients who presented with traumatic brain injury and were admitted in this hospital over 2 years. Authors also reviewed the literatures to study the factors affecting outcome after geriatric TBI and studied the role of aggressive neurosurgical management in geriatric TBI.Results: Among 68%(n=75) of the patients were male and 32% females. Age group of 60-65 years was the highest with 60.9% patients. Patients with GCS of 8 and below had the highest mortality rates of 68 %. Overall mortality rate was 32.72% and 9.09 % of the patients survived in a vegetative condition. The proportion of injury secondary to fall was the largest single group in 50.9% patients, and Chronic SDH was the most common pathology seen in 36.45 % patients. Highest mortality was seen in patients with Diffuse Axonal Injury (69.23 %). Out of the 110 patients , 57 patients underwent surgery for various pathologies. Chronic SDH were the most common operated pathology followed by acute SDH. Glassgow outcome scale was used as the measure of outcome in these series of patients. 32.72 % patients had a GOS score of 1 and 9.09 % had a score of 2. 18.18 % patients remained severely disabled with a score of 3 and nine patients (8.18 %) had a score of 4 and thirty five patients had good recovery (GOS-5).Conclusions: Due to the better treatment options there is an increase in the number of elderly around the world. Thus, the number of eldery individuals presenting with TBI to the emergency department is also on the rise more commonly due to falls than road traffic accidents. There is a need for specific prognostic and management guidelines for the elderly which can lead to better diagnosis, care and recovery and eventual short- and long-term outcomes in the elderly.

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

Cited by 52 publications

References 21 publications

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

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

Do older patients with acute or subacute subdural hematoma benefit from surgery?

Geriatric head injuries: impact and outcomes

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