Surgical evacuation of acute subdural hematoma in octogenarians: a ten-year experience from a single trauma center

Abstract

Background: Elderly patients presenting with an acute subdural hematoma (aSDH) have historically had unfavorable outcomes.

Methods: We retrospectively reviewed patient records from 2005 through 2015 that were ≥80 years of age and underwent surgical evacuation of aSDH.

Results: Thirty-four patients met inclusion criteria, with a mean age of 84 years (range 80–91). Glascow Outcome Scale (GOS) of 4–5 was deemed a good outcome and a GOS 1–3 was deemed to be a poor outcome. Six patients had good outcome at last follow up and 27 patients had poor outcome. Patients with a higher presenting Glascow Coma Scale (GCS) trended towards better outcome [(good: mean 13.1, median 14.5, IQR 12.5–15) vs. (poor: mean 9.6, median 10, IQR 6–14) p = 0.06]. Patients with a higher in-hospital post-operative GCS score had significantly better overall outcome than patients who left the hospital with a lower GCS score [(good: mean 14.5, median 14.5, IQR 14–15) vs. (poor: mean 8.4, median 9, IQR 4–11) p = 0.001]. Patients with a good outcome had a median aSDH thickness of 17mm (IQR 12.75–19.75) while patients with a poor outcome had a median thickness of 20mm (IQR 16–24.5); p = 0.17. In addition, patients with a good outcome had a median midline shift of 10mm (IQR 6–12.5), while patients with a poor outcome had a median midline shift of 14mm (IQR 10–20); p = 0.07.

Conclusions: The prognosis for elderly patients with large aSDH remains poor, but a subset of patients can benefit from surgical intervention.

Keywords:

• Acute subdural hematoma
• craniotomy
• craniectomy
• octogenarians

Disclosure statement

Michael McGinity has no conflict of interest and no financial disclosures to declare.

Joel Michalek has no conflict of interest and no financial disclosures to declare.

Jesse Rodriguez has no conflict of interest and no financial disclosures to declare.

John Floyd has no conflict of interest and no financial disclosures to declare.

This study has no external funding.