💬Editorial: Decade-long follow-up highlights that patients with surgically treated ChronicSubduralHematoma have persistent excess mortality and long-term cognitive and functional impairment, even when overall quality of life appears preserved.
In the setting of aging populations and rising antithrombotic use, chronic subdural hematomas (cSDH) are increasingly common in high-income countries. While discussed in the medical literature for centuries,1 clinical research on cSDH in the modern era initially focused on surgical approaches and the risk of short-term mortality and recurrence.2-4 In this setting, cSDH was perceived to be a relatively benign disease; however, recent work has challenged this reputation. Patients with cSDH have persistently elevated long-term mortality when compared with controls,5 and those who survive are often left with functional and cognitive impairment.6 Unfortunately, most prior studies of long-term outcomes were small or had limited data on premorbid health, and none had data on functional status or quality of life.
In this issue of JAMA Neurol ogy, Petutschnigg et al7 expand on this work by examining mortality, function, and quality of life 10 years after surgical management of cSDH. To achieve this, they used patients who had previously been enrolled in a cSDH clinical trial from 2012 through 2016, which was conducted at a single center in Switzerland and examined the use of routine follow-up computed tomography scans in surgically managed patients with cSDH. The study authors obtained all-cause mortality for all 359 participants through 2023 using a nationwide data source. Each patient was then matched by age, sex, and birth month to controls from the Swiss population. Then, they obtained health-related quality of life by administering a validated survey to consenting participants, getting a response in 147 of 202 survivors at a mean of 10.55 years from the cSDH. Results from these participants were compared with normative values for a European population, using standardized age and sex strata.
The authors7 found a significantly higher mortality rate among patients with cSDH when compared with controls, with the absolute risk difference widening from 6% at 1 year to 18% at 10 years. Among those who survived, both men and women showed significant impairment in cognitive and role functioning (ie, how much their daily work/hobbies are impaired) when compared with normative controls. In addition, men (but not women) showed significant additional impairment in physical functioning and social functioning when compared with normative controls. Importantly, perceived quality of life was not reduced in either men or women. Discordance between functional impairments and perceived quality of life has been observed in other types of brain injury, a phenomenon termed the disability paradox,8 and should similarly caution against therapeutic nihilism when it comes to patients with cSDH.
