Abstract
ObjectiveTo assess possible long-term excess mortality and causes of death of patients with chronic subdural hematoma (CSDH).MethodsA 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).ResultsThe 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).ConclusionsPatients 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.
Highlights
Chronic subdural hematoma (CSDH) is a common disease in neurosurgical practice among elderly patients [1, 3, 27]
The median age for CSDH diagnosis was 76 years, and women were older than men (79 vs. 75 years)
We have previously published the details of CSDH patients from this same patient cohort stratified by gender, age groups, and time periods [32]
Summary
Chronic subdural hematoma (CSDH) is a common disease in neurosurgical practice among elderly patients [1, 3, 27]. The reported annual incidence of CSDH has ranged widely across studies, from 1.7 to 20.6 per 100,000—and the overall incidence is increasing as the global population becomes progressively older [38]. In a prior study using this same patient. Acta Neurochir (2020) 162:1467–1478 cohort, we reported that during a 26-year period between 1990 and 2015, the overall incidence doubled from 8.2 to 17.6/ 100,000/year in the Pirkanmaa region, Finland [32]. The incidence per 100,000 person-years remained quite stable among adults younger than 70 years, whereas the incidence nearly tripled among the population 80 years or older. The global population of people aged 80 and older is expected to more than triple between 2015 and 2050 [17].
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have