Raj Rahul, Mikkonen Era D, Kivisaari Riku, Skrifvars Markus B, Korja Miikka, Siironen Jari
Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
World Neurosurg. 2016 Apr;88:592-597. doi: 10.1016/j.wneu.2015.10.095. Epub 2015 Nov 5.
Surgery for elderly patients with acute subdural hematomas (ASDH) is controversial, because postoperative mortality rates are reported to be high and long-term outcomes unknown. Thus, we aimed to describe midterm and long-term mortality rates of elderly patients operated for an ASDH.
We reviewed all consecutive ≥75-year-old patients operated on for an ASDH between 2009 and 2012. We recorded data on preadmission functional status (independent or dependent) and use of antithrombotic medication. Patients were followed up a median of 4.2 years (range, 2.5-6.4 years).
Forty-four patients were included. The majority of the patients (70%) were independent and taking antithrombotic medication (77%). Independent patients had a 1-year mortality of 42%, compared to 69% for dependent patients; 56% of patients taking antithrombotics and 30% of those without antithrombotics died within the first postoperative year. All patients with an admission Glasgow coma scale score of 3-8 died within the first postoperative year, if they used antithrombotics or were dependent before the injury. Of all 1-year survivors, 77% were alive at the end of follow-up.
In this first surgical case series of 75-year-old or older patients with ASDH, the overall mortality rate appears to be relatively low, especially for preoperatively conscious and independent patients without antithrombotic medication. Patients alive at 1-year after surgery had a life expectancy comparable to their age-matched peers. The prognosis seems to be detrimental for preoperatively unconscious patients who were functionally dependent or used antithrombotic medication before the injury.
老年急性硬膜下血肿（ASDH）患者的手术治疗存在争议，因为据报道术后死亡率较高且长期预后不明。因此，我们旨在描述接受ASDH手术的老年患者的中期和长期死亡率。
我们回顾了2009年至2012年间所有连续接受ASDH手术的≥75岁患者。我们记录了入院前功能状态（独立或依赖）和抗血栓药物使用的数据。对患者进行了中位4.2年（范围2.5 - 6.4年）的随访。
纳入44例患者。大多数患者（70%）独立且使用抗血栓药物（77%）。独立患者的1年死亡率为42%，而依赖患者为69%；使用抗血栓药物的患者中有56%在术后第一年内死亡，未使用抗血栓药物的患者中这一比例为30%。所有入院时格拉斯哥昏迷量表评分为3 - 8分的患者，如果在受伤前使用抗血栓药物或依赖他人，均在术后第一年内死亡。在所有1年幸存者中，77%在随访结束时仍存活。
在这个首个针对75岁及以上ASDH患者的手术病例系列中，总体死亡率似乎相对较低，尤其是对于术前意识清醒、独立且未使用抗血栓药物的患者。术后1年存活的患者预期寿命与年龄匹配的同龄人相当。对于术前无意识、功能依赖或在受伤前使用抗血栓药物的患者，预后似乎较差。
