Sex and age differences in patients treated surgically for acute subdural hematoma

IF 2.5 Q3 CLINICAL NEUROLOGY

Brain & spine Pub Date : 2025-01-01 DOI:10.1016/j.bas.2025.105602

Anna Koller , Christoph Reich , Claudius Thomé , Daniel Pinggera

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Abstract

Introduction

Acute subdural hematoma (aSDH) is a severe condition with high mortality despite advances in neurosurgical care. Predicting outcomes remains challenging due to individual variability. This study explores sex- and age-related differences in surgical treatment and outcomes of aSDH.

Research question

How does sex and age influence surgical decision-making and outcomes in patients undergoing surgery for acute subdural hematoma?

Material and methods

We retrospectively analyzed 328 patients treated surgically for aSDH between 2005 and 2015. Demographic data, clinical characteristics (GCS), radiological parameters, surgical approach (osteoplastic craniotomy [OC] vs. decompressive craniectomy [DC]), and outcomes (Glasgow Outcome Scale [GOS]) at discharge were collected.

Results

The cohort included 211 men (mean age: 56) and 117 women (mean age: 68). Hematoma volumes were similar between sexes (p = 0.9), yet surgical choices differed significantly (OC in 58 % of women vs. 43 % of men; p = 0.008). Elderly patients (>70 years; n = 133) had larger hematoma volumes than younger patients (64.6 vs. 44.8 cm³; p < 0.0001) and were more frequently treated with OC (68 % vs. 35 %; p < 0.0001). Age and hematoma volume—but not sex—were independent predictors of surgical approach. Outcome (GOS) was worse in elderly patients (p < 0.001) and those undergoing DC (p = 0.001). Time to CT correlated with outcome (p = 0.001), while time to surgery did not.

Discussion and conclusion

Despite comparable hematoma volumes, surgical strategies varied by sex and age. Elderly patients with larger hematomas were less likely to receive DC. These findings highlight demographic influences on surgical decision-making and support a more individualized approach in managing aSDH.

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急性硬膜下血肿手术治疗患者的性别和年龄差异

急性硬膜下血肿（aSDH）是一种严重的疾病，尽管神经外科治疗取得了进展，但死亡率很高。由于个体差异，预测结果仍然具有挑战性。本研究探讨了aSDH手术治疗和预后的性别和年龄相关差异。研究问题：性别和年龄如何影响急性硬膜下血肿手术患者的手术决策和结果？材料和方法我们回顾性分析了2005年至2015年间328例手术治疗aSDH的患者。收集患者出院时的人口学资料、临床特征（GCS）、影像学参数、手术入路（骨成形术[OC] vs减压术[DC]）和结局（格拉斯哥结局量表[GOS]）。结果男性211例，平均年龄56岁；女性117例，平均年龄68岁。血肿体积在两性之间相似（p = 0.9），但手术选择有显著差异（女性为58%，男性为43%；p = 0.008）。老年患者（>；70岁；n = 133）血肿体积大于年轻患者（64.6比44.8 cm3; p < 0.0001），并且更频繁地接受OC治疗（68%比35%；p < 0.0001）。年龄和血肿量（而非性别）是手术入路的独立预测因素。老年患者（p < 0.001）和DC患者（p = 0.001） GOS较差。CT时间与预后相关（p = 0.001），而手术时间与预后无关。讨论与结论：尽管血肿量相当，但手术策略因性别和年龄而异。血肿较大的老年患者接受DC的可能性较小。这些发现强调了人口统计学对手术决策的影响，并支持更个性化的方法来管理aSDH。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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