Extreme-aged patients (≥ 85 years) experience similar outcomes as younger geriatric patients following chronic subdural hematoma evacuation: a matched cohort study

Peyton L Nisson; John J Francis; Michelot Michel; Keshav Goel; Chirag G Patil

doi:10.1007/s11357-024-01081-8

Extreme-aged patients (≥ 85 years) experience similar outcomes as younger geriatric patients following chronic subdural hematoma evacuation: a matched cohort study

Geroscience. 2024 Jan 30. doi: 10.1007/s11357-024-01081-8. Online ahead of print.

Authors

Peyton L Nisson¹, John J Francis^{2

3}, Michelot Michel^{2

4}, Keshav Goel⁵, Chirag G Patil²

Affiliations

¹ Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA. peyton.nisson@cshs.org.
² Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
³ School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
⁴ College of Medicine, University of Florida, Gainesville, FL, USA.
⁵ David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.

PMID: 38286851
DOI: 10.1007/s11357-024-01081-8

Abstract

Subdural hematoma (SDH) evacuation represents one of the most frequently performed neurosurgical procedures. Several reports cite a rise in both the age and number of patient's requiring treatment, due in part to an aging population and expanded anticoagulation use. However, limited data and conflicting conclusions exist on extreme-aged geriatric patients (≥ 85 years of age) after undergoing surgery. Patients undergoing SDH evacuation at a tertiary academic medical center between November 2013-December 2021 were retrospectively identified. The study group consisted of patients ≥ 85 years (Group 1) diagnosed with a chronic SDH surgically evacuated. A control group was created matching patients by 70-84 years of age, gender, and anticoagulation use (Group 2). Multiple metrics were evaluated between the two including length-of hospital-stay, tracheostomy/PEG placement, reoperation rate, complications, discharge location, neurological outcome at the time of discharge, and survival. A total of 130 patients were included; 65 in Group 1 and 65 in Group 2. Patient demographics, medical comorbidities, SDH characteristics, international normalized ratio, partial thromboplastin time, and use of blood thinning agents were similar between the two groups. Kaplan Meier survival analysis at one-year was 80% for Group 1 and 76% for Group 2. No significant difference was identified using the log-rank test for equality of survivor functions (p = 0.26). All measured outcomes including GCS at time of discharge, length of stay, rate of reoperations, and neurological outcome were statistically similar between the two groups. Backwards stepwise conditional logistic regression revealed no significant association between poor outcomes at the time of discharge and age. Alternatively, anticoagulation use was found to be associated with poor outcomes (OR 3.55, 95% CI 1.08-11.60; p = 0.036). Several outcome metrics and statistical analyses were used to compare patients ≥ 85 years of age to younger geriatric patients (70-84 years) in a matched cohort study. Adjusting for age group, gender, and anticoagulation use, no significant difference was found between the two groups including neurological outcome at discharge, reoperation rate, and survival.

Keywords: Age; Geriatric; Nonagenarians; Octogenarian; Risk factor; Subdural hematoma; Subdural hematoma evacuation.