Sex and Racial Differences in Chronic Subdural Hematoma Outcomes: A National Database Study of 202,830 Patients

Introduction: Chronic subdural hematoma (cSDH) is a common neurosurgical condition with significant morbidity in aging populations. Despite advances in treatment, potential disparities in outcomes based on patient demographics remain understudied. This study investigates differences in cSDH outcomes between male and female patients, as well as between White and African American cohorts, to identify potential disparities and inform targeted quality improvement efforts.

Methods: TriNetX, a national research network, was retrospectively queried to identify 202,830 cSDH patients between 2012 and 2022. Of these patients, 121,955 were male and 80,875 were female. Also , there were 15,274 African Americans, and 97,777 white patients. Thus we had two analyses: one between males and females, and one between African-American and White patients. One-to-one propensity score matching for age,sex (only in race cohorts), race( only in sex-based cohorts), and comorbidities was conducted to balance cohorts. The incidence of in outcomes were then assessed within the one-year postoperative periods, and compared using a t-test.

Results: After propensity score matching, for the sex-based analysis there were 77,764 patients in each cohort. Male patients had significantly higher odds of undergoing craniotomy or burr hole evacuation of their hematoma [odds ratio (OR): 1.557, 95% confidence interval (CI): (1.494,1.624)], coma (1.076, (1.023,1.131)), and brain compression (1.165, (1.116,1.215)). After propensity score matching for the race cohorts, there were 15,272 patients in each cohort. African Americans were much more likely to develop seizures (1.209, (1.14,1.282)), brain compression (​​1.196, (1.094,1.307)), craniotomy or burr hole evacuation (1.342, (1.225,1.471)), coma (1.147, (1.039,1.267)), blindness (1.342, (1.163,1.55)), and cerebral edema (1.129, (1.034,1.233)). All of these results were significant with p< 0.05.

Conclusion : Male patients demonstrated higher rates of surgical intervention and increased risk of coma and brain compression. More pronounced disparities were observed in the racial analysis, with African American patients showing significantly higher odds across multiple adverse outcomes. These findings highlight the need for further research and suggest that both sex and race should be considered as important factors in risk stratification and management of cSDH patients.