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. 2022 Dec;164(12):3133-3141.
doi: 10.1007/s00701-022-05373-w. Epub 2022 Sep 29.

Mortality after chronic subdural hematoma is associated with frailty

Jurre Blaauw  1   2 , Bram Jacobs  3 , Heleen M den Hertog  4 , Niels A van der Gaag  5 , Korné Jellema  6 , Ruben Dammers  7 , Kuan H Kho  8   9 , Rob J M Groen  10 , Joukje van der Naalt  3 , Hester F Lingsma  11
Affiliations

Mortality after chronic subdural hematoma is associated with frailty

Jurre Blaauw et al. Acta Neurochir (Wien). 2022 Dec.

Abstract

Purpose: Chronic subdural hematoma (CSDH) is a common neurological disease often affecting the elderly. Long-term excess mortality for patients after CSDH has been suggested but causes of death are unknown. We hypothesize that excess mortality of CSDH patients is related to frailty. In this article, we describe mortality rates and causes of death of CSDH patients compared with the general population and assess the association of frailty with mortality.

Methods: A cohort study in which consecutive CSDH patients were compared to the general population regarding mortality rates. Furthermore, the association of six frailty indicators (cognitive problems, frequent falling, unable to live independently, unable to perform daily self-care, use of benzodiazepines or psychotropic drugs, and number of medications) with mortality was assessed.

Results: A total of 1307 CSDH patients were included, with a mean age of 73.7 (SD ± 11.4) years and 958 (73%) were male. Median follow-up was 56 months (range: 0-213). Compared with controls CSDH patients had a hazard ratio for mortality of 1.34 (95% CI: 1.2-1.5). CSDH patients more often died from cardiovascular diseases (37% vs. 30%) and falls (7.2% vs. 3.7%). Among CSDH patients frequent falling (HR 1.3; 95% CI: 1.0-1.7), inability to live independently (HR 1.4, 95% CI: 1.1-1.8), inability to perform daily self-care (HR 1.5; 95% CI: 1.1-1.9), and number of medications used (HR 1.0; 95% CI: 1.0-1.1) were independently associated with mortality.

Conclusions: CSDH patients have higher mortality rates than the general population. Frailty in CSDH patients is associated with higher mortality risk. More attention for the frailty of CSDH patients is warranted.

Keywords: Chronic Subdural hematoma; Frailty; Mortality; Survival.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Kaplan–Meier curve for survival time in months of CSDH patients (green) vs. matched controls (red). Time on the X-axis represented in months, transparent zones around line represent 95% confidence intervals
Fig. 2
Fig. 2
Forest plot of the association of frailty indicators and survival in a full model. Adjusted for age, sex, MGS score, CCI score, and receiving surgical treatment
See this image and copyright information in PMC

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