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Chronic subdural hematoma in aging population – How the age influence the outcome after surgical treatment

PS072

Ulasavets, Uladzislau*; Grzywna, Ewelina

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doi: 10.1016/j.pbj.2017.07.149
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Aim: The aim of our work is to examine how the age influence the outcome after surgical treatment of chronic subdural hematoma.

Introduction: Chronic subdural hematoma (CSDH) is a common condition, characterized by the collection of hemolyzed blood between dura and arachnoid mater of the brain surrounded by two pathological hematoma membranes - internal and external. The number of CSDH incidence increases with age and it is why more attention should be directed for surgical treatment in elder patients group.

Methods: Data on management and outcomes for patients with CSDH were collected retrospectively from years 2014–2017 and investigated using statistic methods. The study group was divided into two subgroups according to the age: <75 years and ≥75 years old. Age, gender, comorbidities, neurological status on admission and at discharge, pre-/postoperative epilepsy, surgical technique were investigated.

Results: We analyzed 257 patients with a diagnosis CSDH. Analyzed subgroups have not differ significantly except the gender and concomitant diseases according to the Chi2 and exact Fisher tests. We found craniotomy in patients ≥75 years old increases the risk of postoperative epilepsy compering to the bur-hole (logistic regression analysis: 9.8 [95% CI: 1.9–49.8], p=.006), same as the internal hematoma membrane removal during surgery (logistic regression analysis: 10.3 [95% CI: 2.0–52.15], p=.005). These dependencies do not occur in the younger age group. Type of treatment have not influenced the mRS in patients younger than 75 years old. In elder patients reoperation and removal of the internal membrane of the hematoma worsened outcome measured in mRS (logistic regression analysis: 5.5 [95% CI: 1.4–20.90], p=.013 and 3.1 [95% CI: 1.4–7.2], p=.007).

Conclusion: Craniotomy and internal membrane removal increase the risk of epilepsy in elder CSDH patients. Reoperation and hematoma internal membrane removal are the risk factors of unfavorable outcome in patients ≥75 years old.

© 2017 by Lippincott Williams & Wilkins, Inc.