Craniotomy versus craniectomy for traumatic acute subdural hematoma—coarsened exact matched analysis of outcomes.

• DC versus CO patients had different baseline characteristics and initial injury severity. • Age and initial CT findings were independently associated with surgical approach. • After applying coarsened exact matching to patients who underwent CO and DC, DC remained independently associated with inpatient mortality. • DC was also independently associated with mortality at 90-days and 1-year after surgery. Acute subdural hematoma (aSDH) after traumatic brain injury frequently requires emergent craniotomy (CO) or decompressive craniectomy (DC). We sought to determine the variables associated with either surgical approach and to compare outcomes between matched patients. A multi-center retrospective review was used to identify traumatic aSDH patients who underwent CO or DC. Patient variables independently associated with surgical approach were used for coarsened exact matching. Multivariate logistic regression and multivariate Cox proportional-hazards regression were conducted on matched patients to determine independent predictors of mortality. Seventy-six patients underwent CO and sixty-two underwent DC for aSDH evacuation. DC patients were 21.4 years younger (P < 0.001), more likely to be male (80.6 % vs 60.5 %, P = 0.011), and present with GCS ≤ 8 (64.5 % vs 36.8 %, P = 0.001). Age (P < 0.001), epidural hematoma (P = 0.01), skull fracture (P = 0.001), and cisternal effacement (P = 0.02) were independently associated with surgical approach. After coarsened exact matching, DC (P = 0.008), older age (P = 0.007), male sex (P = 0.04), and intraventricular hemorrhage (P = 0.02), were independently associated with inpatient mortality. Multivariate Cox proportional-hazards regression demonstrated that DC was independently associated with mortality at 90-days (P = 0.001) and 1-year post-operation (P = 0.003). aSDH patients who receive surgical evacuation via DC as opposed to CO are younger, more likely to be male, and have worse clinical exam. After controlling for patient differences via coarsened exact matching, DC is independently associated with mortality. [ABSTRACT FROM AUTHOR]