Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Has the Timing of the Surgery a Major Role in Influencing Outcome in Elderly Patients with Acute Subdural Hematomas?

Gianluca Trevisi
ORCID logo ,
Alba Scerrati
ORCID logo ,
Oriela Rustemi
ORCID logo ,
Luca Ricciardi
* ,
Tamara Ius
ORCID logo ,
Anna Maria Auricchio
ORCID logo ,
Pasquale De Bonis
,
Alessio Albanese
,
Annunziato Mangiola
,
Rosario Maugeri
,
Federico Nicolosi
,
Carmelo Lucio Sturiale
ORCID logo
Version 1 : Received: 18 August 2022 / Approved: 23 August 2022 / Online: 23 August 2022 (05:08:46 CEST)

A peer-reviewed article of this Preprint also exists.

Trevisi, G.; Scerrati, A.; Rustemi, O.; Ricciardi, L.; Ius, T.; Auricchio, A.M.; De Bonis, P.; Albanese, A.; Mangiola, A.; Maugeri, R.; Nicolosi, F.; Sturiale, C.L. Does the Timing of the Surgery Have a Major Role in Influencing the Outcome in Elders with Acute Subdural Hematomas? J. Pers. Med. 2022, 12, 1612. Trevisi, G.; Scerrati, A.; Rustemi, O.; Ricciardi, L.; Ius, T.; Auricchio, A.M.; De Bonis, P.; Albanese, A.; Mangiola, A.; Maugeri, R.; Nicolosi, F.; Sturiale, C.L. Does the Timing of the Surgery Have a Major Role in Influencing the Outcome in Elders with Acute Subdural Hematomas? J. Pers. Med. 2022, 12, 1612.

Abstract

Background: The incidence of traumatic acute subdural hematomas (ASDH) in elderly is increasing. Despite surgical evacuation, these patients have poor survival and low rate of functional outcome, and surgical timing plays a no clear role as predictor. We investigated if the timing of surgery has a major role in influencing outcome in these patients.Methods: We retrospectively retrieved clinical and radiological data of all patients ≥70 years operated on for post-traumatic ASDH in a 3 years period in 5 Italian Hospitals. Patients were divided in 3 surgical timing groups from hospital arrival: ultra-early (within 6h); early (6-24h); delayed (after 24h). Outcome was measured at discharge using two endpoints: survival (alive/dead) and functional outcome at Glasgow Outcome Scale (GOS). Univariate and multivariate predictor models were constructed.Results: We included 136 patients. About 33% died for consequences of ASDH and among the survivors only 24% were in good functional outcome at discharge. Surgical timing groups appeared different according to presenting GCS, which was on average lower in ultra-early surgery group, and radiological findings, which appeared worse in the same group. Delayed surgery was more frequent in patients with subacute clinical deterioration. Surgical timing appeared associated neither with survival nor with functional outcome also after stratification for preoperative GCS. Preoperative midline shift was the strongest outcome predictor. Conclusions: An earlier surgery was offered to patients with worse clinical-radiological findings. Also after stratification for GCS it was not associated with better outcome. Among the radiological markers, preoperative midline shift was the strongest outcome predictor.

Keywords

acute subdural hematoma; comorbidity; elderly; outcome; surgery; timing of surgery; traumatic brain injury

Subject

Medicine and Pharmacology, Neuroscience and Neurology

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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