Long-Term Mortality, Cognition, and Quality of Life After Chronic Subdural Hematoma Surgery

Thomas Petutschnigg, MD1; Samuel Aschwanden1; Claire Descombes, MSc1 et al

2026년 04월13일

JAMA Neurol. Published online: April 13, 2026.

Doi: 10.1001/jamaneurol.2026.0656

Abstract

Importance  Chronic subdural hematoma (cSDH) is among the most common neurosurgical disorders in older adults. Although short-term outcomes after surgery are favorable, long-term survival and health-related quality of life (HRQoL) remain poorly characterized.

Objectives  To evaluate long-term survival, excess mortality, and HRQoL 10 years after surgical treatment of cSDH.

Design, Setting, and Participants  This population-matched cohort study was conducted at a single tertiary referral center in Switzerland, with mortality follow-up through December 31, 2023 (mean [SD] follow-up, 9.55 [1.24] years), and cross-sectional HRQoL assessment through December 31, 2024 (mean [SD] follow-up, 10.05 [1.16] years). Analyses were conducted from October to December 2025. Adults surgically treated for cSDH between June 2012 and August 2016 were included, matched with the Swiss general population by age, sex, and birth month for mortality analysis. Among survivors, those completing HRQoL assessment were compared with age- and sex-weighted European reference values.

Exposure  Surgically treated cSDH.

Main Outcomes and Measures  The primary outcome was all-cause mortality, estimated using Kaplan-Meier analysis, with excess mortality expressed as absolute survival differences and standardized mortality ratios (SMRs). Secondary outcomes were the following HRQoL domains: cognitive functioning (CF), physical functioning (PF), role functioning (RF), emotional functioning (EF), social functioning (SF), and global QoL, compared using 2-sided z tests.

Results  A total of 359 adults surgically treated for cSDH were included; among survivors, 147 completed HRQoL assessment and were compared with age- and sex-weighted European reference values. Among 359 patients (mean [SD] age, 73.4 [11.0] years; 117 female patients [32.6%]), overall survival was significantly lower than matched controls (hazard ratio [cohort vs control], 2.02; 95% CI, 1.73-2.37; log-rank P < .001). One-year survival in the cSDH cohort was 92.8% (95% CI, 90.1%-95.5%) vs 98.8% (95% CI, 98.7%-98.8%) in controls, representing an excess mortality of 6.0 percentage points (SMR, 3.22; 95% CI, 2.10-4.72); 5-year survival was 76.6% (95% CI, 72.3%-81.1%) vs 88.2% (95% CI, 88.2%-88.3%), representing an excess of 11.6 percentage points (SMR, 1.19; 95% CI, 0.95-1.47); and 10-year survival was 55.5% (95% CI, 50.3%-61.3%) vs 73.5% (95% CI, 73.4%-73.6%), representing an excess of 18.0 percentage points (SMR, 1.12; 95% CI, 0.94-1.31). Men reported significantly lower mean (SD) PF scores (75.9 [26.8] vs control mean score, 83.22; P < .001), RF scores (74.9 [32.0] vs 84.87; P < .001), CF scores (77.6 [22.6] vs 87.38; P < .001), and SF scores (84.3 [24.0] vs 90.00; P = .02) than controls, and women reported lower mean (SD) RF (69.0 [30.9] vs 80.91; P = .02) and CF scores (70.2 [24.8] vs 86.50; P < .001). EF and global QoL did not differ significantly from European reference values.

Conclusions and Relevance In this population-matched cohort study, patients surgically treated for cSDH experienced sustained excess mortality and clinically relevant HRQoL deficits 10 years after surgery. These findings call for structured postoperative and rehabilitative care beyond the acute phase.

Key Points

Question What are the long-term survival and health-related quality of life outcomes in patients surgically treated for chronic subdural hematoma (cSDH)?

Findings In this 10-year follow-up cohort study of 359 patients, survival was 18 percentage points lower than in an age- and sex-matched general population (55.5% vs 73.5%), and survivors reported persistent cognitive and functional impairments despite overall preserved global quality of life.

Meaning Patients with surgically treated cSDH experience sustained excess mortality and long-term self-reported cognitive and functional impairments, underscoring the need for comprehensive postoperative and rehabilitative care beyond the perioperative episode.

Figure 1.  Kaplan-Meier Curve: Chronic Subdural Hematoma (cSDH) Cohort vs Matched General Population

요약

·         중요성 : 만성 경막하 혈종(cSDH)은 고령자에서 가장 흔한 신경외과 질환 중 하나임. 수술 후 단기 예후는 비교적 양호하지만, 장기 생존율과 건강 관련 삶의 질(HRQoL)은 충분히 규명되지 않음

·         목적 : cSDH 수술 후 10년 시점의 장기 생존율, 초과 사망률, 그리고 삶의 질을 평가하고자 함

·         설계, 환경 및 대상자 : 스위스의 단일 3차 의료기관에서 수행된 인구 매칭 코호트 연구

-사망 추적: 2023년 12월 31일까지 (평균 추적 기간 9.55년)

-삶의 질 평가: 2024년 12월 31일까지 (평균 추적 기간 10.05년)

-분석 기간: 2025년 10월 ~ 12월

-2012년 6월부터 2016년 8월까지 cSDH로 수술받은 성인을 포함

-사망률 분석을 위해 스위스 일반 인구와 연령, 성별, 출생 월을 기준으로 매칭함

-생존자 중 삶의 질 평가를 완료한 환자들은 유럽 기준(reference) 값과 비교함

·         노출 : 수술적 치료를 받은 만성 경막하 혈종(cSDH)

·         주요 결과 및 측정치:

1. 1차 결과

-전체 사망률 (all-cause mortality)

-Kaplan-Meier 분석 사용

-초과 사망률: 절대 생존율 차이, 표준화 사망비(SMR)

2. 2차 결과 (삶의 질 영역)

-인지 기능 (CF)

-신체 기능 (PF)

-역할 기능 (RF)

-정서 기능 (EF)

-사회 기능 (SF)

-전반적 삶의 질

→ 양측 z 검정을 이용해 비교

·         결과 : 총 359명의 환자가 포함되었으며, 그 중 생존자 147명이 삶의 질 평가를 완료함

1. 기본 특성

-평균 연령: 73.4세

-여성: 32.6%

2. 생존율-전체 생존율은 대조군보다 유의하게 낮음

-위험비(HR): 2.02 (P < .001)

-1년 생존율 : cSDH: 92.8% vs 대조군: 98.8%

  →초과 사망률: 6.0% (SMR: 3.22)

- 5년 생존율 : cSDH: 76.6% vs 대조군: 88.2%

  →초과 사망률: 11.6% (SMR: 1.19)

-10년 생존율: cSDH: 55.5% vs 대조군: 73.5%

  →초과 사망률: 18.0% ( SMR: 1.12)

3. 삶의 질 (HRQoL)

-남성: 대조군보다 유의하게 낮음

→신체 기능 (PF), 역할 기능 (RF), 인지 기능 (CF), 사회 기능 (SF)

-여성: 대조군보다 낮음

 →역할 기능 (RF), 인지 기능 (CF)

-차이없음: 정서 기능 (EF). 전반적 삶의 질 (global QoL)

·         결론 및 의의 : cSDH로 수술받은 환자들은 10년 후에도 지속적인 초과 사망률과 임상적으로 의미 있는 삶의 질 저하를 보였다.