Surgical Treatment of Chronic Subdural Hematomas in Nonagenarians: Who to Treat?

World Neurosurg. 2020 Oct 14;S1878-8750(20)32227-0. doi: 10.1016/j.wneu.2020.10.035. Online ahead of print.

Abstract

Objective: Although chronic subdural hematomas (cSDH) are often treated surgically it remains plausible that invasive treatment in elderly patients may have a negative effect on survival. The aim of this study was to characterize survival following neurosurgical intervention for cSDH in a selected cohort aged >90 years and to identify prognostic factors that may inform clinical decision-making.

Methods: In total, we identified a cohort of 548 consecutive patients who had undergone burr hole drainage for cSDH in a 5-year period between 2009-2013. Of these patients, 41 were aged >90 years. For each patient, information was gathered from local hospital records, general practice records, and the patients directly. Long-term survival was compared with actuarial data obtained from the National Life Tables.

Results: Overall mortality at the time of discharge was 2%. Mortality was 26.8% at 6 months, 36.8% at 1 year, and 47.9% at 2 years. Interestingly, there was no significant difference between the actuarial curve and the survival curve following surgery (hazard ratio, 1.17; confidence interval, 0.67-2.05; P = 0.57). Despite initially departing from the actuarial curve, the survival curve becomes parallel at approximately 1 year. Multivariate analysis showed that preadmission residence and the number of comorbid conditions were significant predictors of survival.

Conclusions: We advocate that neurosurgical intervention for cSDH in selected nonagenarians can be a safe and beneficial procedure. Patients living independently at home and with a limited past medical history were most likely to benefit from the surgery.

Keywords: Chronic subdural hematomas; Elderly; Nonagenarians.