Superiority of craniotomy over supportive care for octogenarians and nonagenarians in operable acute traumatic subdural hematoma

• Published in: Clinical neurology and neurosurgery 2022-01, Vol.212, p.107069-107069, Article 107069
• Main Authors: Duehr, James, Rodriguez-Torres, Sebastian, Njoku-Austin, Confidence, Patel, Kevin, Deng, Hansen, Hamilton, D. Kojo, Okonkwo, David O., Puccio, Ava M., Nwachuku, Enyinna L.
• Format: Article
• Language: English
• Subjects: Age; Aged; Aged, 80 and over; Blood; Brain; Craniotomy; Dura mater; Female; Follow-Up Studies; Geriatric surgery; Geriatrics; Hematoma; Hematoma, Subdural, Acute - surgery; Hematoma, Subdural, Acute - therapy; Humans; Male; Medical prognosis; Meninges; Mortality; Neurology; Neurosurgery; Outcome and Process Assessment, Health Care; Palliative Care; Patients; Population studies; Radiography; Subdural hematoma; Subgroup analysis; Surgery; Survival; Survival analysis; Trauma; Traumatic brain injury
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2021.107069

Neurosurgical evacuation in elderly trauma patients is controversial. We analyzed impact of craniotomy for acute subdural hematoma on survival in octogenarians and nonagenarians. Methods The study population included all patients aged ≥ 80 years who presented with acute traumatic SDHs 09/01/15 – 01/01/20, with radiography indicating operative eligibility (i.e. MLS >5 mm and/or overall thickness >10 mm). Of 1054 TBIs aged ≥ 80 years, 104 (9.87%) were surgically indicated. Of these, 35 received craniotomy and 69 received supportive measures due to family/patient wishes or surgeon’s professional decision. We analyzed these data using a Poisson regression adjusted for influence of covariates. Of 35 craniotomies, 21 (60.00%) were deceased at 2 years of follow-up, compared to 48 (69.57%) deceased of 69 non-surgical patients. No significant demographic differences existed between these groups, other than age (craniotomy patients were younger; median age 84 vs 86; p