University of Massachusetts Medical School Faculty Publications

Title

Outcomes in octogenarians with subdural hematomas

UMMS Affiliation

Department of Surgery

Date

2-18-2013

Document Type

Article

Medical Subject Headings

Hematoma, Subdural; Aged, 80 and over; Outcome Assessment (Health Care)

Disciplines

Cardiovascular Diseases | Epidemiology | Geriatrics | Health Services Research | Nervous System Diseases | Neurology | Surgery

Abstract

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 (P80 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.

Comments

Citation: Clin Neurol Neurosurg. 2013 Feb 18. pii: S0303-8467(13)00044-9. doi: 10.1016/j.clineuro.2013.01.017. Link to article on publisher's site

Related Resources

Link to Article in PubMed