Introduction: The mortality rate for elderly patients with surgery for acute subdural hematoma (aSDH) has been reported to be as high as 90%, but with the possibility of functional survivors, surgery is still frequently performed. Therefore, we examined our outcomes for patients 70 years and older who underwent craniotomy for aSDH.

Methods: We retrospectively reviewed patients 70 years and older who had an open surgical intervention for aSDH between 2006 and 2016 at Memorial Hermann Hospital in Houston, Texas. A multivariable analysis of the clinical data and outcomes was then performed.

Results: Of the 112 patients reviewed, 95% sustained their injuries after a fall from standing. The mortality rate was 42 %, but 24% of patients were discharged to home or to a rehabilitation facility. Multivariable analysis demonstrated that age, preexisting dementia, and surgery type had significant impact on outcome. Specifically, patient who were older than 80 years of age, had dementia or Parkinson’s disease, or who required decompressive craniectomy (as opposed to craniotomy) had a worse outcome.

Conclusions: Elderly patients with aSDH requiring surgery have a high likelihood of death or significant disability. It is important to note that the mortality rate for large aSDHs is higher given that some patients with this disease were not deemed to be surgical candidates and therefore were not included in this study. However, up to one quarter of surgical patients will be functional enough to go home or to a rehabilitation facility from the hospital. The data suggest that age over 80 years old, dementia, or cerebral edema significant enough to warrant decompressive craniectomy are associated with an increased risk of death.

Patient Care: Guide decision making to help identify patients that will likely benefit form surgical intervention and those who may not.

Learning Objectives: 1) Describe the importance of the having an effective treatment decision process regarding the increasing elderly population and subsequent increase in falls leading to acute subdural hematomas. 2) Discuss, in small groups the role for craniotomy to evacuate acute subdural hematomas in properly selected elderly patients. 3) Identify an effective treatment for the optimally selected patients over 70 years old with acute subdural hematomas.

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