Age and salvageability: analysis of outcome of patients older than 65 years undergoing craniotomy for acute traumatic subdural hematoma

Background: We are in an aging population and many elderly people are prone to falling and suffering an acute traumatic subdural hematoma (aSDH). Yet, the operative treatment of patients older than 65 years of age for aSDH remains controversial, and very limited data exists with regard to expected outcome in this elderly patient group.

Methods: We retrospectively analyzed 37 consecutive patients (all >65 years) who underwent craniotomy for aSDH in our department between January 1, 2002 and December 31, 2007.

Results: Thirty-seven consecutive patients (54% women, 46% men) were treated for aSDH by means of craniotomy and duraplasty. Median age was 73 years (interquartile range, 10 years). Thirty patients (81%) had significant comorbidities and 43% of patients were treated by anticoagulation or thrombocyte aggregation inhibitors. Median initial Glasgow coma scale score was 8 (interquartile range, 7), and 51% had pupillary abnormalities. Perioperative morbidity occurred in 12 of 37 patients (32%), and 13 patients died in the postoperative period (35%). Overall outcome according to Glasgow outcome scale (GOS) was favorable (GOS, 4 and 5) in 15 of 37 patients (41%); severely disabled (GOS, 3) in 8 of 37 (22%), and unfavorable (GOS, 1 and 2) in 14 of 37 (38%).

Conclusions: Craniotomy for patients older than 65 years of age remains controversial, and our case series seems to support the notion that surgical treatment is associated with significant postoperative morbidity, mortality, and adverse outcome. However, selected patients benefit from an intervention, with a good outcome in 41% of patients.