gms | German Medical Science

Objective: As a result of the demographic shift in western societies, the mean age at presentation of patients suffering from chronic subdural hematomas (cSDH) is increasing. Therapeutic strategies, surgical and non-surgical, need to be reevaluated and adapted accordingly. Age is known to be a positive risk factor. The purpose of this study is to determine if old age (>85 years) should be seen as a contraindication for surgical treatment.

Method: Two groups (56 patients each) with cSDH over and below 85 years of age from a single neurosurgical department with well-defined surgical treatment guidelines were retrospectively analyzed. Clinical characteristics of the patients, localization, treatment, prior medication and complications were compared. Outcome was measured by clinical improvement postoperatively (complete neurological recovery) and by the Glasgow Outcome Scale (GOS) at one month after surgery.

Results: Age over 85 years was associated with higher GOS one month after surgery (p=0.038). 51.8% (58) of all patients had complete neurological recovery, 43 (74%) of these patients were over 85 years. Both groups had a comparable mean hospitalization time (9.8 days for patients >85 years and 9.5 days for patients <85 years). However, elderly patients suffered from a significantly higher complication rate (p<0.001) with odds of having a complication of 18.3 times higher (p<0.001) compared to patients <85 years.

Conclusions: Despite significant higher complication rate in elderly patients, the outcome assessed by the Glasgow Outcome Scale (GOS) at one month after surgery was significantly better in comparison to patients with <85 years.

Note: Phillip J. Slotty and Marcel Alxander Kamp contributed equally.