title: Surgery for chronic subdural hematoma in nonagenarians: A Scandinavian population-based multicenter study.
abstract: OBJECTIVE
  Chronic subdural hematoma (cSDH) is a prevalent condition often seen in the elderly, with surgery being the treatment of choice when symptomatic. So far, few have explored the surgical outcomes in patients 90 years or older. The aim of this study was to investigate outcome after cSDH surgery in nonagenarians (≥90 y/o group) compared to younger adult patients (<90 y/o group).
  
  
  METHODS
  In a Scandinavian population-based cohort we conducted a retrospective review of 1,254 patients undergoing primary burr-hole procedures for cSDH between January 1, 2005 and December 31, 2010 at three neurosurgical centers. In a comparative analysis, the primary end-point was difference in hematoma recurrence rates between the ≥90 y/o and <90 y/o groups. The secondary end-points were differences in perioperative morbidity and mortality between groups.
  
  
  RESULTS
  75 patients were 90 years or older. There was no significant difference in recurrences resulting in reoperation between the age groups (10.7% vs 13.6%, P=.47). There was also no significant difference in overall complication rate (4.1% vs 8.1%, P=.21) or severe complications (1.4% vs 2.0%, P=.68). There were three (4.0%) perioperative deaths within 30 days in the ≥90 y/o group and 40 (3.4%) in the <90 y/o group (P=.78).
  
  
  CONCLUSIONS
  Patients 90 years or older had similar rates of recurrence, perioperative morbidity and perioperative mortality as compared to younger patients. Age alone should not be a contraindication for surgery in patients with cSDH.
authors.affiliation: Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet and Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.|Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
authors.forename: J
authors.identifier: http://orcid.org/0000-0002-2911-1914
authors.initials: J
authors.lastname: Bartek
authors.affiliation: Department of Neurosurgery, University Hospital of North Norway, Tromsø, Norway.
authors.forename: K
authors.initials: K
authors.lastname: Sjåvik
authors.affiliation: Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet and Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: F
authors.initials: F
authors.lastname: Ståhl
authors.affiliation: Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet and Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: H
authors.initials: H
authors.lastname: Kristiansson
authors.affiliation: Department of Neurosurgery, St.Olav University Hospital, Trondheim, Norway.|Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.|Norwegian National Advisory Unit for Ultrasound and Image-Guided Therapy, St.Olav Hospital, Trondheim, Norway.
authors.forename: O
authors.initials: O
authors.lastname: Solheim
authors.affiliation: Department of Neurosurgery, St.Olav University Hospital, Trondheim, Norway.|Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: S
authors.initials: S
authors.lastname: Gulati
authors.affiliation: Department of Neurosurgery, St.Olav University Hospital, Trondheim, Norway.|Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.|Norwegian National Advisory Unit for Ultrasound and Image-Guided Therapy, St.Olav Hospital, Trondheim, Norway.
authors.forename: L M
authors.initials: LM
authors.lastname: Sagberg
authors.affiliation: Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet and Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Förander
authors.affiliation: Department of Neurosurgery, St.Olav University Hospital, Trondheim, Norway.|Department of Neurosurgery, Sahlgrenska Univerity Hospital, Gothenburg, Sweden.|Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden.
authors.forename: A S
authors.initials: AS
authors.lastname: Jakola
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D016330:Frail Elderly; D020200:Hematoma, Subdural, Chronic / Q000601:surgery*; D006801:Humans; D008297:Male; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D012008:Recurrence
keywords: chronic subdural hematoma; nonagenarians; old; outcome; surgery