Outcomes in octogenarians with subdural hematomas.

Clinical neurology and neurosurgery

PubMedID: 23428139

Pilitsis J, Atwater B, Warden D, Deck G, Carroll J, Smith J, Ng SC, Tseng J. Outcomes in octogenarians with subdural hematomas. Clin Neurol Neurosurg. 2013;115(8):1429-32.
OBJECTIVE
In the majority of literature concerning age in TBI, specifically in subdural hematomas (SDH), the mean age of patients considered elderly is 55-65. Limited data in SDH patients>75 years suggest an increased mortality rate. The impact of medical decision making on these data is not well-documented.

PATIENTS/METHODS
We use the Nationwide Inpatient Sample (NIS) database to compare outcomes between SDH patients 60-79 and =80. As administrative databases have some shortcomings, i.e. in-hospital data only, acute and chronic SDHs listed together, we examined institutional data to evaluate the impact of these factors on medical decision making which may falsely elevate mortality rates.

RESULTS
In-hospital mortality was increased in NIS patients>80 treated both surgically and non-surgically (P<0.05). Our institutional data confirmed higher in-hospital mortality rates in patients>80 with SDHs as a group. However, the SDH patients>80 who underwent surgery at our institution had much lower mortality rates. We found that patients=80 made up 87% of all patients with "surgical lesions" that were not operated on. Type of subdural, admission GCS, and baseline cognitive status appeared to have a significant impact on surgical decision making.

CONCLUSION
This study examines mortality rates in patients>80 with SDHs who are managed surgically and non-surgically using a large administrative database and institutional data. It provides preliminary insight into medical decision making which make affect mortality rates of the very elderly.