Long-term excess mortality after chronic subdural hematoma

Abstract

Objective To assess possible long-term excess mortality and causes of death of patients with chronic subdural hematoma (CSDH). Methods A retrospective study (1990-2015) of adult patients (n = 1133, median age = 76 years old, men = 65%) with CSDH identified by ICD-codes and verified by medical records. All patients were followed until death or the end of 2017. Cumulative relative survival ratios and relative excess risks of death (RER) were estimated by comparing patients' mortality with that in the entire regional matched population. The causes of death were compared with a separate reference group formed by randomly choosing sex, age, and calendar time matched controls (4 controls per each CSDH patient). Results The median follow-up time was 4.8 years (range = 0-27 years), and 710 (63%) of the patients died (median age at death = 84 years old). The cumulative excess mortality was 1 year = 9%, 5 years = 18%, 10 years = 27%, 15 years = 37%, and 20 years = 48%. A subgroup of CSDH patients (n = 206) with no comorbidity had no excess mortality. Excess mortality was related to poor modified Rankin score at admission (RER = 4.93) and at discharge (RER = 8.31), alcohol abuse (RER = 4.47), warfarin (RER = 2.94), age ≥ 80 years old (RER = 1.83), non-operative treatment (RER = 1.56), and non-traumatic etiology (RER = 1.69). Hematoma characteristics or recurrence were unrelated to excess mortality. Dementia was the most common cause of death among the CSDH patients (21%) and the third most common cause in the reference group (15%, p < 0.001). Conclusions Patients with CSDH have continuous excess mortality up to 20 years after diagnosis. Patient-related characteristics have a strong association with excess mortality, whereas specific CSDH-related findings do not. CSDH patients have an increased risk for dementia-related mortality.

Risk of Recurrence of Chronic Subdural Hematomas After Surgery: A Multicenter Observational Cohort Study

“…Risk factors for recurrence are still debated and there is no universal consensus regarding the best surgical technique or optimal preand postoperative management (6,7). The possible impact of recurrences after surgical treatment of a CSDH on the overall fatality rate is also extensively debated (8), although in most investigations and in the practical clinical situation of extremely old patients suffering from multiple major comorbidities, reliable information concerning the "disease specificity" profile of the fatality rate of CSDH recurrences appear to be still elusive and difficult to collect (8).…”

Functional recovery following surgery for chronic subdural hematoma

“…[ 12 ] However, an interesting recent study examined the relative excess mortality of cSDH patients with age-matched population over the course of 25 years. [ 13 ] They found an overall excess mortality related to cSDH of 9% at 1 year, 27% at 10 years, and 48% at 20 years, independent of hematoma characteristics and recurrence.…”

The Mini-Craniotomy for cSDH Revisited: New Perspectives

“…overall incidence is 1.7 to 20.6 per 100,000 population (1)(2)(3). This is a common neurosurgical problem and it has been estimated that it will likely be the most common cranial neurosurgical procedure by the year 2025 (4,5).…”

“…There is a high incidence of dementia and other cognitive and emotional sequelae in patients with cSDH (8). Whether this is an expected finding in this age group or whether this is related to the cSDH has been debated (2).…”

“…Additionally, there are long term sequelae of both operated and unoperated cSDH. In a long-term retrospective study (1990–2015) in Finland, the patients with cSDH had continuous excess mortality up to 20 years after the diagnosis ( 2 ). Additionally, the presence of the cSDH has been associated with neuronal degeneration and cerebral atrophy as measured on serial imaging studies.…”