Mortality and causes of death after surgery for chronic subdural hematoma: a post hoc study of the FINISH randomized trial

Abstract

Purpose: Chronic subdural hematoma (CSDH) is a common neurosurgical disease, especially prevalent among the elderly and is associated with reduced life expectancy. This study investigated mortality and causes of death after burr-hole drainage surgery for CSDH. Methods: We included patients from the FINISH trial, a national, multicenter, randomized study conducted in Finland during 2020–2022. We obtained mortality data from Statistics Finland. For the classification of causes of death, we used the European shortlist of 86 causes, which is derived from the 10th revision of the International Classification of Diseases and Related Health Problems (ICD-10). Results: Overall, the FINISH trial population included 589 patients (median age 78 years, 28% women). After a median follow-up of 16.4 months (IQR 9.7–23.1), 82 patients (14%) died. The median age at death was 85 years (IQR 81–89), and the median time from surgery to death was 6.5 months (IQR 2.4–15.3). The leading causes of death were circulatory diseases (34%), accidents (16%), and dementia (15%). A higher number of pre-existing comorbidities was significantly associated with increased mortality. In particular, dementia, cardiac arrhythmia, prior cerebrovascular events, and hypertension emerged as significant risk factors for death. Conclusion: This study provides valuable insights into mortality rates and causes of death among patients undergoing CSDH surgery. The findings underscore the critical role of pre-existing comorbidities in influencing patient outcomes. Trial Registration: The FINISH trial was registered with ClinicalTrials.gov (NCT04203550) on Dec 16, 2019. The trial is completed.