OBJECTIVE To assess possible long-term excess mortality and causes of death of patients with chronic subdural hematoma (CSDH). METHODS A retrospective study (1990-2015) of adult patients (n = 1133, median age = 76 years old, men = 65%) with CSDH identified by ICD-codes and verified by medical records. All patients were followed until death or the end of 2017. Cumulative relative survival ratios and relative excess risks of death (RER) were estimated by comparing patients' mortality with that in the entire regional matched population. The causes of death were compared with a separate reference group formed by randomly choosing sex, age, and calendar time matched controls (4 controls per each CSDH patient). RESULTS The median follow-up time was 4.8 years (range = 0-27 years), and 710 (63%) of the patients died (median age at death = 84 years old). The cumulative excess mortality was 1 year = 9%, 5 years = 18%, 10 years = 27%, 15 years = 37%, and 20 years = 48%. A subgroup of CSDH patients (n = 206) with no comorbidity had no excess mortality. Excess mortality was related to poor modified Rankin score at admission (RER = 4.93) and at discharge (RER = 8.31), alcohol abuse (RER = 4.47), warfarin (RER = 2.94), age ≥ 80 years old (RER = 1.83), non-operative treatment (RER = 1.56), and non-traumatic etiology (RER = 1.69). Hematoma characteristics or recurrence were unrelated to excess mortality. Dementia was the most common cause of death among the CSDH patients (21%) and the third most common cause in the reference group (15%, p < 0.001). CONCLUSIONS Patients with CSDH have continuous excess mortality up to 20 years after diagnosis. Patient-related characteristics have a strong association with excess mortality, whereas specific CSDH-related findings do not. CSDH patients have an increased risk for dementia-related mortality.

中文翻译：

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慢性硬膜下血肿后的长期过高死亡率。

目的评估慢性硬膜下血肿（CSDH）患者可能的长期过度死亡率和死亡原因。方法一项回顾性研究（1990-2015年），对成年患者（n = 1133，中位年龄= 76岁，男性= 65％）的CSDH进行了ICD代码识别并经医疗记录验证。所有患者均被随访直至死亡或2017年底。通过将患者的死亡率与整个区域匹配人群的死亡率进行比较，估算出累积相对存活率和相对超额死亡风险（RER）。将死亡原因与通过随机选择性别，年龄和日历时间匹配的对照（每名CSDH患者4个对照）组成的独立参考组进行比较。结果中位随访时间为4.8年（范围= 0-27年），710例（63％）患者死亡（死亡中位年龄= 84岁）。累积超额死亡率为1年= 9％，5年= 18％，10年= 27％，15年= 37％和20年= 48％。没有合并症的CSDH患者亚组（n = 206）没有过高的死亡率。死亡率过高与入院时（RER = 4.93）和出院时（RER = 8.31），酗酒（RER = 4.47），华法林（RER = 2.94），年龄≥80岁（RER = 1.83）的改良兰金评分差有关。 ，非手术治疗（RER = 1.56）和非创伤性病因（RER = 1.69）。血肿特征或复发与过度死亡率无关。痴呆是C​​SDH患者中最常见的死亡原因（21％），而在参考组中是第三位最常见的原因（15％，p <0.001）。结论CSDH患者在诊断后长达20年间持续超额死亡率。与患者相关的特征与死亡率过高密切相关，而与CSDH相关的特定发现则没有。CSDH患者罹患痴呆症相关死亡率的风险增加。