gms | German Medical Science

Objective: As life expectancy continues to rise in Western countries, neurosurgeons are confronted with an increasing number of geriatric patients suffering from chronic subdural hematoma (CSDH). Studies have determined geriatric patients to be at higher risk for surgical complications, and age has been deemed a risk factor for poor outcome in surgical series of CSDH. In this study, we aimed to determine if frailty, and not age, can better stratify the risk of elderly patients with CSDH for poor outcome and mortality.

Methods: We conducted a matched cohort study of elderly patients undergoing twist-drill craniostomy under local anesthesia for CSDH. We evaluated patients based on traditional predictors of poor outcome, such as Glasgow Coma Scale (GCS) at admission, Markwalder grade, anticoagulant use, and hematoma volume. We assessed their frailty with the Clinical Frailty Scale (CFS) and their outcome based on the Glasgow Outcome Scale (GOS). Good outcome was defined as GOS 4-5. We stratified patients in two groups according to age, ≥85 years, and ≥65<85 years.

Results: A total of 42 patients aged 85 or older were identified and matched to a cohort of 42 patients aged between 65 and 84. In an ANOVA analysis, no statistically significant differences were observed in the baseline characteristics of both groups. Good outcome was observed in n=28/42, 66.7% of younger patients, and n=24/42, 57.1% of older patients, with mortality rates of 9.5% and 4.8%, respectively. These differences were not statistically significant. In a linear regression analysis, GCS and CFS were predictors of outcome and mortality, but not age.

Conclusion: In a continuously aging population, clinical assessment of patients with CSDH based on their premorbid functionality and frailty appears to be more informative than age alone for outcome prognostication.