124 Craniotomy Versus Craniectomy for Traumatic Acute Subdural Hematoma Coarsened Exact Matched Analysis of Outcomes

Abstract

INTRODUCTION: Previous studies comparing craniotomy (CO) versus decompressive hemicraniectomy (DC) for acute subdural hematoma (aSDH) evacuation after traumatic brain injury have not found significant association between surgical approach and patient outcome. We hoped to provide a more granular and real-world assessment of outcomes. METHODS: One hundred thirty-eight patients underwent CO (N = 76) or DC (N = 62) for traumatic aSDH. DC patients were on average 21.4 years younger (P < 0.001), more likely to be male (80.6% vs 60.5%, P = 0.011), and present with GCS = 8 (64.5% vs 36.8%, P = 0.001). Age (P < 0.001), EDH (P = 0.01), skull fracture (P = 0.001), and cisternal effacement (P = 0.02) were independently associated with surgical approach. After coarsened exact matching, DC (P = 0.008), older age (P = 0.007), male sex (P = 0.04), and IVH (P = 0.02), were independently associated with inpatient mortality. Multivariate Cox proportional-hazards regression demonstrated that DC was independently associated with mortality at 90-days (P = 0.001) and 1-year post-operation (P = 0.003) for matched patients. RESULTS: One hundred thirty-eight patients underwent CO (N = 76) or DC (N = 62) for traumatic aSDH. DC patients were on average 21.4 years younger (P < 0.001), more likely to be male (80.6% vs 60.5%, P = 0.011), and present with GCS = 8 (64.5% vs 36.8%, P = 0.001). Age (P < 0.001), EDH (P = 0.01), skull fracture (P = 0.001), and cisternal effacement (P = 0.02) were independently associated with surgical approach. After coarsened exact matching, DC (P = 0.008), older age (P = 0.007), male sex (P = 0.04), and IVH (P = 0.02), were independently associated with inpatient mortality. Multivariate Cox proportional-hazards regression demonstrated that DC was independently associated with mortality at 90-days (P = 0.001) and 1-year post-operation (P = 0.003) for matched patients. CONCLUSIONS: aSDH patients who receive surgical evacuation via DC as opposed to CO are younger, more likely to be male, and have worse clinical exam. After controlling for patient differences via coarsened exact matching, DC is an independent predictor of mortality at discharge, as well as at 90-days and 1-year after surgery.