Impact of surgical timing on chronic subdural hematoma outcomes: novel insights from a multicenter study

Objective: Chronic Subdural Hematoma (CSDH) is one of the most frequently encountered conditions in the neurosurgical practice. The role of timing in CSDH surgery in mild symptomatic patients remains uncertain. The aim of this study was to analyze the prognostic role of surgical timing in patients with mild symptomatic CSDH. Methods: In this multicenter retrospective study, patients diagnosed with mild symptomatic CSDH who underwent surgical evacuation were enrolled. Marwalder Grading System (MGS) and GCS scores were used for neurological evaluation. Patients presenting with preoperative GCS score ≥ 13 and MGS score ≤ 2 scores were defined as “mild symptomatic”. A ROC curve analysis was used to identify the optimal surgical timing associated with favorable postoperative outcome. Univariate and multivariate analysis were used to verify the association between surgical timing and postoperative neurological outcome, length of hospitalization, and postoperative complication. Results: A total of 160 patients were enrolled in the study. The mean latency from hospital admission to surgical intervention was 2.5 ± 3.2 days. All patients treated with surgical evacuation demonstrated postoperative clinical improvement in terms of GCS and/or MGS scores. The univariate and multivariate analyses demonstrated significantly better neurological outcomes and shorter length of hospitalization in patients treated within 3 days from hospital admission. No statistically significant associations were demonstrated between surgical timing and postoperative complication. Conclusions: This is the first study to identify a specific surgical timing cut-off in the treatment of mildly symptomatic CSDH associated with improved clinical outcomes and recovery, offering a potential reference point for clinical decision-making. Patients who underwent surgery within three days from hospital admission exhibited significantly better postoperative neurological outcomes and shorter hospital stays. Surgical timing did not influence postoperative complications, including hematoma recurrence or the need for early reintervention.