Higher 30-day mortality, poor outcomes linked to early surgery in older adults with TBI

Key takeaways:

• Patients who underwent early surgical intervention had the worst presentation and the poorest outcomes.
• 30-day mortality also was higher in patients treated conservatively vs. those undergoing delayed surgery.

In older adults with traumatic brain injury and acute subdural hematoma, early neurosurgical intervention resulted in the highest 30-day mortality rates, while delayed surgery yielded better outcomes.

“Elderly patients with TBI frequently suffer from intracranial hematomas,” Rebeca Alejandra Gavrila Laic, MSc, a PhD researcher in biomechanics KU Leuven in Belgium, and colleagues wrote in Brain and Spine. “In particular, acute subdural hematoma is the most common injury type in elderly admitted to hospital after TBI, often accompanied by cerebral contusions.”

Laic and fellow researchers examined outcomes after acute subdural hematoma evacuation in patients aged 65 years or older by screening clinical records of nearly 3,000 individuals with TBI at University Hospital Leuven between 1999 and 2019.

Researchers identified 149 patients for analysis (median age at injury, 75-78 years) and defined severity of TBI using Glasgow Coma Scale (GCS) score. Fall accidents were the main cause of TBI in all patients.

According to results, 32 patients underwent early surgery, 33 had delayed surgery and 84 were treated conservatively, of whom 40.6%, 33.3% and 40.5%, respectively, were aged 80 years or older.

Participants who underwent early surgery had the lowest median GCS, poorest CT scores, longest hospital and ICU stays, and highest ICU admission and redo surgery rates. Data additionally showed that 30-day mortality was 21.9% for those undergoing early surgery, 3% for late surgery and 16.7% among the conservative treatment group.

“Patients who underwent early neurosurgical treatment had the highest 30-day mortality rates, but also presented with the most severe injuries at admission,” Laic and colleagues wrote. “Patients who underwent delayed surgery had a better outcome.”

They added, “Future prospective studies with a sufficient sample size are warranted to draw more definitive conclusions on the value of early vs. late surgery in elderly patients with [acute subdural hematoma].”