Predictors of Postoperative Neurological Outcome After Surgical Evacuation of Traumatic Acute Subdural Hematoma: A Retrospective Cohort Study

Background: Traumatic acute subdural hematoma (ASDH) is a severe consequence of traumatic brain injury and is associated with substantial mortality and neurological disability among surgically treated patients.Objective: To identify clinical, physiological, radiological, and operative factors associated with unfavorable three-month neurological outcome and to support risk stratification among patients undergoing surgical evacuation of traumatic ASDH.Methods: This retrospective cohort study included 120 adults who underwent surgical evacuation of traumatic ASDH at Ghurki Trust Teaching Hospital, Lahore, between March 2025 and March 2026.Demographic, clinical, radiological, and perioperative variables were evaluated.The primary outcome was unfavorable neurological status at three months, defined as a Glasgow Outcome Scale-Extended (GOSE) score of 1-4.Multivariable logistic regression was used to identify factors independently associated with unfavorable outcomes.As all participants underwent surgery and no non-operative comparison group was included, the study was designed to evaluate prognostic associations rather than the effect of surgical evacuation itself.Results: The mean age was 50.8 ± 17.9 years; 75 (62.5%)patients were male, and 45 (37.5%) were female.An unfavorable neurological outcome occurred in 74 (61.7%) patients, and three-month mortality was 21.7% (26/120).Factors independently associated with unfavorable outcome were admission Glasgow Coma Scale ≤8 (aOR 4.86, 95% CI 2.05-11.50),bilateral non-reactive pupils (aOR 4.10, 95% CI 1.13-14.86),age per 10year increase (aOR 1.42, 95% CI 1.13-1.79),preoperative hypotension (aOR 2.79, 95% CI 1.01-7.71),midline shift >10 mm (aOR 2.53, 95% CI 1.07-5.98),and compressed or absent basal cisterns (aOR 2.71, 95% CI 1.12-6.57).The model showed apparent good discrimination with an in-sample AUC of 0.86.Conclusion: Greater neurological injury severity, bilateral nonreactive pupils, preoperative hypotension, increasing age, and CT markers of intracranial mass effect were independently associated with unfavorable three-month neurological outcome among surgically treated patients with traumatic ASDH.These findings may assist postoperative risk stratification but should not be interpreted as evidence of the effectiveness or appropriateness of surgical evacuation.