Frailty Is Associated With Decreased Survival in Adult Patients With Nonoperative and Operative Traumatic Subdural Hemorrhage: A Retrospective Cohort Study of 381,754 Patients

Objective:. We investigated frailty’s impact on traumatic subdural hematoma (tSDH), examining its relationship with major complications, length of hospital stay (LOS), mortality, high level of care discharges, and survival probabilities following nonoperative and operative management. Background:. Despite its frequency as a neurosurgical emergency, frailty’s impact on tSDH remains underexplored. Frailty characterized by multisystem impairments significantly predicts poor outcomes, necessitating further investigation. Methods:. A retrospective study examining tSDH patients ≥18 years and assigned an abbreviated injury scale score ≥3, and entered into ACS-TQIP between 2007 and 2020. We employed multivariable analyses for risk-adjusted associations of frailty and our outcomes, and Kaplan-Meier plots for survival probability. Results:. Overall, 381,754 tSDH patients were identified by mFI-5 as robust—39.8%, normal—32.5%, frail—20.5%, and very frail—7.2%. There were 340,096 nonoperative and 41,658 operative patients. The median age was 70.0 (54.0–81.0) nonoperative, and 71.0 (57.0–80.0) operative cohorts. Cohorts were predominately male and White. Multivariable analyses showed a stepwise relationship with all outcomes P