VOLUME 18 NUMBER 2 (July to December 2025)

Factors affecting survival of chronic subdural hematoma patients in multiple centers in the Philippines

Chronic subdural hematoma (CSDH) refers to indolent accumulation of blood and blood products in the subdura. Once symptoms appear, surgical management is recommended, although around 40-60% can be managed conservatively with dexamethasone, atorvastatin or tranexamic acid. The decision on whether surgical management should be instituted in these cases is important, especially in developing countries as oftentimes, neurosurgery is not cheap, only partially covered by insurance and culturally difficult to administer if the evidence is unsure. Filipino patients admitted and diagnosed with CSDH in the 3 major hospitals in a province in the Philippines within the last 10 years were included. General and clinical data including age, sex and other factors that may influence survival were extracted and analysed using Cox PH regression analysis. The failure event was either death or vegetative state on discharge. There were 91 patients included in the study, with 18.9% experiencing the failure event. Using stratified Cox PH Regression analysis, either using DM or HPN as the stratifying variable, no significant difference in the hazard of causing PVS or death whether surgery or conservative management was used (HR: 1.41, p=0.72). Moreover, among the factors included, only intubation and presence of pneumonia were significant factors identified that may influence survival. Among patients admitted for CSDH in a province in the Philippines, surgery appears to have no benefit over conservative management in improving survival outcomes.