Outcomes of Surgical Evacuation of Chronic Subdural Hematoma in the Aged: Institutional Experience and Systematic Review

• Published in: World neurosurgery Vol. 144; pp. 270 - 282.e1
• Main Authors: Dowlati, Ehsan, Sarpong, Kwadwo, Triano, Matthew, Kamande, Stanley, Black, Jordan, Mai, Jeffrey C., Anaizi, Amjad N., Felbaum, Daniel R.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-12-2020
• Subjects: Aged; Chronic subdural hematoma; Elderly; mRS; Surgical outcome; Chronic subdural hematoma; OR; CI; GOS; Surgical outcome; mRS; LOS; SDH; MGS; Aged; cSDH; ICU; Elderly; BMI
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2020.08.118

Surgical intervention for chronic subdural hematoma (cSDH) in the elderly population remains a clinical challenge given that associated morbidity and outcomes do not always equate radiographic success with clinical success. Our objective was to compare outcome measures of 2 age groups of patients undergoing surgical intervention for cSDH evacuation and to perform a systematic review of the literature related to this topic.
A retrospective analysis of adult patients undergoing surgical evacuation of cSDH at our institution was performed. Primary outcome measures of modified Rankin Scale (mRS) score at discharge and 3 months were assessed. In addition, a systematic search was performed to collect all relevant studies addressing outcomes after surgical intervention in aged patients with cSDH.
There were 72 patients in the younger cohort (<70 years) and 113 patients in the aged cohort (≥70 years). Multivariate analysis showed significant association between age and higher mRS score at discharge and 3 months follow-up. There were also significant differences in length of stay and disposition between the 2 groups. Twenty-one studies were reviewed, and 11 studies were included in a meta-analysis of recurrence rates between studied age groups.
The aged cohort had worse outcomes than the younger cohort as determined by mRS score at discharge and 3 months. A systematic review of outcomes is provided with limited meta-analysis because of the heterogenous nature of outcome reporting and the observational design of previous studies. Further studies with standardized reporting and long-term follow-up are warranted to further study outcomes in this increasing population.
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