Role of Early Surgical Intervention in Acute Subdural Hematoma: A Comparative Study
Background: Acute subdural hematoma (ASDH) is a life-threatening condition associated with high morbidity and mortality. Timely surgical intervention plays a critical role in improving patient outcomes; however, the optimal timing of surgery remains a subject of ongoing debate. Objective: To evaluate the impact of early versus delayed surgical intervention on mortality, functional outcomes, and postoperative complications in patients with ASDH. Methods: This prospective observational comparative study was conducted over a period of 24 months (January 2024 to December 2025) in the Neurosurgery department of Saidu Medical College and Saidu Group of Teaching Hospitals, Swat, Khyber Pakhtunkhwa. A total of 140 patients diagnosed with ASDH and requiring surgical evacuation were included. Patients were divided into two groups: early intervention (<4 hours) and delayed intervention (>4 hours), with 70 patients in each group. Data regarding demographics, clinical presentation, and radiological findings were recorded. Outcomes were assessed in terms of mortality, Glasgow Outcome Scale (GOS) at 3 months, and postoperative complications. Statistical analysis was performed using SPSS version 26. Results: The mean age of patients was 42.6 ± 15.3 years, with a male predominance (72.9%). Mortality was significantly lower in the early intervention group compared to the delayed group (20% vs 40%, p = 0.01). A higher proportion of patients in the early group achieved good recovery (GOS 5) (42.9% vs 25.7%), while poor outcomes were more frequent in the delayed group (p = 0.02). Postoperative complications, including seizures and prolonged ICU stay, were also more common in the delayed intervention group (p = 0.03). Conclusion: Early surgical intervention in ASDH is associated with significantly improved survival, better functional outcomes, and reduced postoperative complications. Prompt surgical management should be prioritized to optimize patient outcomes. Keywords Acute subdural hematoma; Early surgical intervention; Traumatic brain injury; Glasgow Outcome Scale; Mortality; Neurosurgery; Craniotomy; Surgical timing