title: Mortality in Elderly Patients Operated for an Acute Subdural Hematoma: A Surgical Case Series.
abstract: BACKGROUND
  Surgery for elderly patients with acute subdural hematomas (ASDH) is controversial, because postoperative mortality rates are reported to be high and long-term outcomes unknown. Thus, we aimed to describe midterm and long-term mortality rates of elderly patients operated for an ASDH.
  
  
  METHODS
  We reviewed all consecutive ≥75-year-old patients operated on for an ASDH between 2009 and 2012. We recorded data on preadmission functional status (independent or dependent) and use of antithrombotic medication. Patients were followed up a median of 4.2 years (range, 2.5-6.4 years).
  
  
  RESULTS
  Forty-four patients were included. The majority of the patients (70%) were independent and taking antithrombotic medication (77%). Independent patients had a 1-year mortality of 42%, compared to 69% for dependent patients; 56% of patients taking antithrombotics and 30% of those without antithrombotics died within the first postoperative year. All patients with an admission Glasgow coma scale score of 3-8 died within the first postoperative year, if they used antithrombotics or were dependent before the injury. Of all 1-year survivors, 77% were alive at the end of follow-up.
  
  
  CONCLUSIONS
  In this first surgical case series of 75-year-old or older patients with ASDH, the overall mortality rate appears to be relatively low, especially for preoperatively conscious and independent patients without antithrombotic medication. Patients alive at 1-year after surgery had a life expectancy comparable to their age-matched peers. The prognosis seems to be detrimental for preoperatively unconscious patients who were functionally dependent or used antithrombotic medication before the injury.
authors.affiliation: Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Electronic address: rahul.br.raj@icloud.com.
authors.forename: Rahul
authors.initials: R
authors.lastname: Raj
authors.affiliation: Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Era D
authors.initials: ED
authors.lastname: Mikkonen
authors.affiliation: Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Riku
authors.initials: R
authors.lastname: Kivisaari
authors.affiliation: Division of Intensive Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Markus B
authors.initials: MB
authors.lastname: Skrifvars
authors.affiliation: Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Miikka
authors.initials: M
authors.lastname: Korja
authors.affiliation: Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Jari
authors.initials: J
authors.lastname: Siironen
mesh_terms: D000368:Aged; D015984:Causality; D015897:Comorbidity; D003399:Craniotomy / Q000401:mortality*; D005260:Female; D005387:Finland / Q000453:epidemiology; D020199:Hematoma, Subdural, Acute / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D015912:Thrombolytic Therapy / Q000401:mortality*; D016896:Treatment Outcome
keywords: Acute subdural hematoma; Craniotomy; Elderly; Mortality; Prognosis; Prognostic factors; Traumatic brain injury