Trauma Mechanisms and Surgical Outcomes in the Elderly Patient with Chronic Subdural Hematoma

Abstract

Background: Chronic subdural hematoma is the preeminent neurosurgical condition in the older population. This retrospective single-centre study focuses on outcome after surgery of chronic subdural hematoma in patients over 70 years.

Methods: Patients treated at a single neurosurgical referral centre between 2010 and 2014 were screened. Included patients were assessed for comorbid conditions, lifestyle factors, and outcomes including recurrence, mortality, and postoperative complications.

Results: A total of 511 patients (70-97 yrs) were identified. 50.7% of patients were treated with anticoagulants and/or antiplatelet therapy. A known probable cause for the hematoma was found in 68.1% of patient's histories. Mortality rate was 3.1% and recurrence was seen in 49 patients (9.6%). Postoperative complications were more common in patients with excessive use of alcohol (p value = .02). Neurological function was improved in 78.1% of patients after the initial surgery. A strategy of delayed contralateral surgery in bilateral hematomas showed low rates of recurrence.

Conclusion: Fall injuries are the most common underlying trauma mechanism in the elderly with chronic subdural hematoma. Recurrence is not more common in the elderly patient group compared to the general population. Excessive alcohol use is a risk factor for post-operative complications.

Keywords: chronic subdural hematoma; fall injuries; mortality; recurrence; surgery.

FIGURE 1

Map of Sweden, showing catchment area for the Neurosurgical Department at Uppsala University Hospital highlighted in blue. The population in the region during the study was 2 million inhabitants, with 270,123 (2010) persons in the age group of interest.

FIGURE 2

Age distribution. Expected distribution noted, with the majority of patients in the age group 80–84, suggesting an increasing frequency of CSDH with advanced age, and tapering off in the oldest age groups where general mortality has taken its toll.

FIGURE 3

Markwalder score before and after surgery. The data show clear improvement after surgery, with most patients relieved of severe symptoms such as impaired consciousness and/or hemiparesis.