Introduction: The American population above 65 years of age will have doubled by 2050 and more nonagenarians will present to neurosurgeons for treatment. Subdural hematomas (SDH) are common in the elderly. Worse outcome is reported in patients 65 years and older, but there are no studies that report outcome of SDH in patients 90 years and older. The objective of this retrospective study is to evaluate outcome in this population.
Methods: We retrospectively reviewed patients 90 years and older with acute and chronic SDH between December 2005 and December 2011. Patients’ clinical characteristics included demographics, GCS at presentation, medical co-morbidities, length of stay, disposition, treatment, radiographic characteristics, and outcomes were collected. Statistical analyses were done using the t-test and Fisher’s Exact test.
Results: We identified 37 patients 90 years or older with 41 admissions for acute or chronic SDH. The median age was 92 (SD=2.31) years. We analyzed 42% acute, 34% chronic and 24% acute on chronic SDH. Twenty patients did not undergo surgery, three of these patients progressed to surgery. Twenty patients had surgery and one patient had surgery twice. Overall, 31% of the patients were discharged to a nursing home, 12% to a rehabilitation facility,32% died or were sent to hospice, and 24% went home.
Disposition to,home, rehabilitation facility, nursing home, hospice or if death occurred was not significantly different between the conservative and operative group (p=0.16) nor were number of comorbidities (p=0.34), or admission GCS (p=0.51) Thickness of SDH and midline shift were significantly (p=0.0003) larger in the operative group. Only 22% patients improved and all but one were from the surgical group (p=0.45).
Conclusions: Surgical intervention is performed in about half of the nonagenarians who present with a SDH. Only 24% of patients were discharged to home. Most improvement were see in the surgical intervention group.
Patient Care: It will help us to discuss the value and necessity of surgical intervention in the elderly. We will see more and more patient in their 80's and 90's with neurosurgical issues but not data exist if intervention improves their overall outcome. Most age thresholds quoted in the literature are 65 years of age or younger.
Learning Objectives: Outcome of SDH in patient 90 years and older.