Analysis of factors influencing short-term prognosis in patients with chronic subdural hematoma: A single-center retrospective cohort study

Background Chronic subdural hematoma (CSDH) is a common condition with variable postoperative outcomes. This study aimed to evaluate the influence of demographic, clinical, and novel inflammatory/metabolic parameters on short-term prognosis in CSDH patients. Methods A single-center retrospective cohort study was conducted on 516 adult patients with CSDH between January 2015 and December 2025. Outcomes included in-hospital mortality, symptomatic recurrence requiring reoperation within 30 days, and length of hospital stay (LOS). Multivariate analyses were performed using Firth logistic regression for rare events and linear regression for LOS. Results In-hospital death occurred in 7 patients (1.4%), and recurrence in 26 patients (5.0%). Multivariate Firth regression identified lower GCS score (OR = 0.68 per point, 95% CI 0.53–0.85, P = 0.001) and older age (OR = 1.10 per year, 95% CI 1.01–1.25, P = 0.032) as independent predictors of mortality. Right-sided hematoma (vs. left) was independently associated with lower recurrence risk (OR = 0.08, 95% CI 0.00–0.87, P = 0.036). Higher platelet count (β = 0.025, P < 0.001), coronary heart disease (β = 2.01, P = 0.025), and higher INR (β = 8.76, P = 0.002) were independently associated with prolonged LOS. Conclusions Baseline neurological status and age are critical determinants of short-term mortality in CSDH. Hematoma laterality predicts recurrence, while platelet count, INR, and coronary heart disease predict resource utilization. The prognostic role of the TyG index was not statistically significant in this cohort and warrants further investigation.