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 cm(3); 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.