Search Results (752)

Prevention of medication-related osteonecrosis of the jaw (MRONJ) associated with low-dose bone-modifying agents (LD-BMAs) remains a clinically relevant challenge, particularly due to the heterogeneity of recommendations and the growing number of patients exposed to these therapies. Unlike high-dose regimens, LD-BMAs are associated with a lower incidence and longer latency of MRONJ, generating uncertainty regarding the optimal timing and scope of dental interventions. This commentary critically compares four major international position papers and consensus documents (AAOMS 2022, SIPMO–SICMF 2020/2024, Chinese Expert Consensus 2024, and SIOT–SIdP 2023) through four pragmatic questions concerning patient stratification, timing of dental assessment, speed of risk reduction, and the role of prescriber-oriented screening tools. The analysis highlights substantial discrepancies among preventive models, particularly regarding whether pre-treatment dental treatments should be mandatory or whether early post-initiation assessment may be acceptable in selected low-risk patients. Full article

Objectives: Frailty, reflecting reduced physiological reserve, has emerged as a predictor of postoperative outcomes in neurosurgery and may provide greater prognostic value than age. In chronic subdural hematoma (cSDH), prospective data remain scarce. This study investigates the association between preoperative frailty, assessed using the Clinical Frailty Scale (CFS), and postoperative recovery in cSDH patients. Methods: In this ongoing prospective single-center cohort study, 78 consecutive patients (≥60 years) with cSDH were enrolled between August 2022 and October 2024. After exclusion of four conservatively managed patients, 74 surgically treated patients were included in the analysis. Frailty was defined as Clinical Frailty Scale (CFS) ≥ 5. The primary outcome was the Glasgow Outcome Scale-Extended at 6 months (GOSE6). Secondary outcomes included GOSE at discharge (GOSE0) and three months (GOSE3), revision surgery, intensive care unit (ICU) admission, and mortality after six months. Results: Higher CFS scores significantly correlated with poorer outcome at 6 months (r = −0.68, p_adj = 0.011). In regression analysis, frailty (p < 0.001), age (p_adj = 0.014), and revision surgery (p_adj = 0.009) were significant predictors of outcome. Frailty was associated with a reduced likelihood of a good neurological outcome (OR = 0.02, 95% CI: [0.004, 0.085]). Frail patients had significantly poorer outcomes at all timepoints (all p_adj = 0.014) and none achieved a favorable outcome (GOSE ≥ 6). Six-month mortality was significantly higher in frail patients compared to non-frail patients (32% vs. 4%, p_adj = 0.048, relative risk RR = 3.29, 95% CI [1.67, 5.78]). Conclusions: Our interim results suggest that preoperative frailty, as measured by the CFS, is strongly associated with poorer neurological recovery and higher mortality following surgical treatment of cSDH. Frailty assessment may facilitate individualized treatment strategies and improve risk stratification beyond age or comorbidity burden. Full article

Background: People living with HIV (PLWH) are increasingly reaching older ages due to the success of antiretroviral therapy. However, aging with HIV is associated with increased risk of multimorbidity, neurocognitive impairment, frailty, psychosocial stress, and functional decline. Multidomain geriatric screening framed within an Age-Friendly 4Ms Framework (Mentation, Medication, Mobility, What Matters Most) and consideration of multi-complexity may help identify aging-related vulnerabilities and guide multidisciplinary care with greater impact on patient outcomes. However, real-world implementation of such programs within HIV clinical settings remains limited. Methods: We conducted a retrospective analysis of adults aged ≥50 years enrolled in a multidisciplinary Healthy Aging Program within a large, integrated HIV care system. Multidomain screening assessments included cognitive evaluation (Montreal Cognitive Assessment), mental health screening (PHQ-2, GAD-2), functional assessment (Katz ADL, Lawton IADL), frailty screening (Edmonton Frail Scale), and intrinsic capacity domains using the WHO Integrated Care for Older People (ICOPE) framework. Screening results, referrals, clinical interventions, and cardiometabolic risk management measures were extracted from clinical program databases and electronic medical records. Results: A total of 317 adults aged ≥50 years completed multidomain screening. Participants had well-controlled HIV infection, with viral suppression in 96.2% and a median CD4 count of 660 cells/mm³. Despite this, aging-related vulnerabilities were common. Overall, 78.4% of participants had at least one abnormal screening domain. Cognitive impairment was identified in nearly half of individuals screened, including mild impairment in 39.8% and moderate impairment in 8.7%. Functional limitations were identified in 10.1% of participants, while anxiety symptoms were present in 9.5%. Sensory impairments were common, including vision impairment in 36.5% of participants. Polypharmacy was prevalent, with 33.2% of participants prescribed five or more chronic medications. Screening frequently generated multidisciplinary referrals, including behavioral health services (42.3%), social work support (42.9%), and pharmacist-led cardiometabolic risk review (56.8%). Age-stratified analyses demonstrated similar prevalence of screening abnormalities across age groups, including individuals aged 50–59 years. Modest improvements in cardiometabolic preventive care were observed during follow-up. Statin utilization increased from 65.6% at baseline to 70.0% at 12 months, and LDL cholesterol declined modestly during the observation period. Conclusions: Multidomain screening integrated into routine HIV care identified a high prevalence of aging-related vulnerabilities among PLWH aged ≥50 years despite excellent virologic control. These findings suggest that aging-related risk in HIV is not adequately captured by chronological age alone and support early, universal implementation of multidomain screening within HIV care models. Full article

Background: Peripheral muscle electrostimulation (PME), encompassing neuromuscular electrical stimulation (NMES) and functional electrical stimulation (FES), has been increasingly acknowledged as an effective adjunctive or complementary treatment to voluntary exercise in elderly cardiac patients who cannot perform sufficient amounts of exercise, for whom there is limited research on optimal protocols. Sarcopenia, defined as a progressive decrease in muscle mass, strength and function, affects approximately 34% of heart failure (HF) patients and considerably worsens their prognosis. The objective of this systematic review is to summarize current evidence on the theoretical mechanisms, physiological pathways, safety and efficacy of PME in older adults within a cardiac rehabilitation (CR) setting, with a specific emphasis on sarcopenia reversal. Methods: We performed a systematic review following the PRISMA 2020 guidelines. A systematic search was conducted on the PubMed, Embase, Cochrane Library, CINAHL and PEDro databases from inception until December 2025. We searched for randomized controlled trials (RCTs) and controlled clinical trials focusing on PME in patients with cardiac diseases aged 65 years or older. The main outcomes were physical function (assessed with the Short Physical Performance Battery [SPPB] and 6 min walk distance [6MWD]), muscle strength, muscle mass and safety. The Cochrane Risk of Bias tool was used to evaluate the quality of the studies. Results: Eight studies were included, with 387 participants and a mean age between 78 and 85 years. PME consistently improved lower-extremity muscle strength (MD: 5.2% body weight, 95% CI = 1.2–9.1, p = 0.013) along with SPPB scores, which ranged from +2.3 to +2.67 points (all p < 0.05). Home-based PME (NMES) achieved 100% adherence rates, and no cardiovascular adverse events were reported. The mechanisms by which PME is beneficial involve peripheral skeletal muscle adaptations without eliciting central hemodynamic stress, increased endothelial function, aerobic enzyme activity, protein anabolism stimulation or muscle proteolysis inhibition. No significant effects were observed on BNP levels, hospital readmissions or mortality. PME has been shown to attenuate the progression of sarcopenia through hypertrophy of type I and II muscle fibers, as well as mitochondrial biogenesis. Conclusions: PME is a safe, feasible adjunct to conventional CR in frail, elderly cardiac patients, particularly those with exercise intolerance and sarcopenia. It improves peripheral muscle function, physical performance, and muscle protein balance without cardiovascular stress. Larger multicenter trials are needed to establish optimal protocols and long-term clinical outcomes. Full article

Background/Objectives: Community-acquired pneumonia (CAP) is a leading cause of mortality in older adults. Traditional prognostic scores may underestimate risk in frail patients by assuming linear relationships between predictors and outcomes. This study aimed to develop and validate explainable machine learning models integrating the administrative Hospital Frailty Risk Score (HFRS) to predict in-hospital mortality in a nationwide cohort of older adults in Chile. Methods: A retrospective cohort study was conducted using anonymized hospital discharge records from the Chilean National Health Fund (FONASA), including 58,306 hospitalization episodes of adults aged ≥60 years across 72 public hospitals. Fourteen supervised machine learning algorithms were trained using five routinely collected predictors: age, sex, HFRS, Charlson Comorbidity Index, and length of stay. Model performance was evaluated on an independent test set using AUC-ROC. SHAP (SHapley Additive exPlanations) values were calculated to assess global and individual predictor contributions. Results: The Extra Trees classifier achieved the highest discriminative performance (AUC-ROC 0.862), outperforming logistic regression (0.642) and other linear models. SHAP analyses identified HFRS as the most influential predictor (mean |SHAP| = 0.66), followed by length of stay, age, and comorbidities. Conclusions: Ensemble tree-based models incorporating administrative frailty measures provide superior mortality prediction compared to traditional linear approaches. Frailty emerged as the primary driver of risk, supporting scalable early stratification using routinely available hospital data. Full article

Background: Anesthetizing frail patients for hip surgery is challenging; spinal (SA) and general anesthesia (GA) often cause hemodynamic instability. Traditional nerve blocks provide analgesia but rarely complete surgical anesthesia without motor block. We evaluate the clinical feasibility of the SAFE (Subarachnoid-alternative Anaesthesia For Endoprosthesis) protocol—combining Anterior Pericapsular Nerve Group (A-PENG), POsterior pericapsular Nerve Group (PONG), and Local Infiltration Analgesia (LIA) under intravenous sedation—as a primary anesthetic preserving motor function and avoiding SA/GA. Methods: This single-center retrospective series analyzed patients undergoing elective or trauma-related hip surgery using the SAFE protocol between September 2022 and April 2026. The primary outcome was success rate (completion without SA/GA conversion). Secondary outcomes included procedural timings, recovery room (RR) transit, and motor preservation. Variables are reported as medians [IQR]. Results: We included 48 patients (median age 83.5 years [IQR: 68.7–87.2]; 66.7% female) undergoing hip hemiarthroplasty (n = 28) or total hip arthroplasty (n = 20). The success rate was 100%, without SA/GA conversion or advanced airway management. Median anesthetic preparation and surgical durations were 55 [IQR: 50–76.2] and 85 min [IQR: 74–110], respectively. RR transit times (recorded for 35 patients) were brief (40 min [IQR: 34.0–67.5]). Crucially, lower-limb motor capacity was preserved in 100% of cases. The technique also proved opioid-sparing, substantially reducing postoperative opioid consumption. Conclusions: The SAFE protocol is a clinically feasible primary anesthetic strategy for hip surgery. By preserving motor function and enabling rapid fast-tracking, it aligns with ERAS pathways, offering a promising alternative to conventional anesthesia for elective and frail trauma patients. Randomized controlled trials are warranted to validate these outcomes. Full article

Frail older adults face an increased risk and severity of sepsis, which contributes to a notably high mortality rate. The management of sepsis in this population presents significant challenges, such as diagnostic complexity, a higher prevalence of multidrug-resistant pathogens, difficulties in achieving effective source control, and an increased risk of adverse events and toxicity associated with antibiotic therapy. In addition, accurate prognostic evaluation based on a comprehensive geriatric assessment is essential to determine the intensity of care required and to develop a personalized plan of care. Despite these considerations, frail older adults are still often underrepresented in randomized clinical trials and guidelines. In this narrative review, we discuss the main pillars of tailored antimicrobial stewardship in frail older adults. We propose a practical, stepwise approach to individualized care, delivered by a multidisciplinary team and based on a careful balance between treatment intensity and patients’ vulnerabilities, needs, and priorities. Full article

Background: Implant-related infection following femoral fracture surgery is a severe complication in elderly patients and is associated with high morbidity and mortality. Most available evidence on periprosthetic joint infection (PJI) derives from elective arthroplasty populations, which differ substantially from patients undergoing surgery for femoral fractures. This study aimed to investigate the microbiological profile and clinical characteristics of implant-related infections after proximal femoral fracture surgery. Materials and Methods: A retrospective observational study was conducted on 20 patients aged ≥70 years who developed implant-related infection after surgical treatment of proximal femoral fractures between 2020 and 2025 at a referral trauma center. Surgical procedures included intramedullary nailing, hemiarthroplasty, and total hip arthroplasty. Only patients with Charlson Comorbidity Index ≥ 4 and infection occurring within one year of the index surgery were included. Clinical, surgical, microbiological, and antibiotic therapy data were retrospectively reviewed. Results: The cohort had a mean age of 82.4 years and a high comorbidity burden (mean Charlson index 4.8). The most frequently isolated pathogen was Staphylococcus aureus (25.9%), with 85% methicillin-resistant strains. Other pathogens included Enterococcus faecalis, Klebsiella pneumoniae, and Escherichia coli. Polymicrobial infections were observed in 25% of patients. One-year mortality was 25%. Conclusions: Implant-related infections after femoral fracture surgery represent a distinct clinical entity compared with elective PJI, characterized by frail patients and a higher prevalence of multidrug-resistant organisms. These findings highlight the need for tailored preventive and therapeutic strategies in this high-risk population. Full article

Background: Radical cystectomy (RC) remains associated with substantial perioperative morbidity despite advances in minimally invasive surgery and reconstructive techniques. Comparisons between intracorporeal reconstruction, robotic-assisted approaches, and urinary diversion strategies are frequently confounded by clinical heterogeneity and patient selection. This study aimed to perform a stratified surgical systematic review evaluating perioperative outcomes across distinct reconstructive pathways following RC. Methods: A PRISMA-guided systematic review identified comparative studies evaluating intracorporeal versus extracorporeal/open orthotopic neobladder reconstruction, robotic-assisted versus open radical cystectomy in frail patients undergoing ureterocutaneostomy, and ileal conduit versus orthotopic urinary diversion. Analyses were performed within predefined clinical modules to preserve surgical context. Outcomes were expressed as odds ratios (ORs) with 95% confidence intervals (CIs), complemented by rare-event sensitivity analyses and exploratory absolute risk metrics, including number needed to treat or harm (NNT/NNH). Continuous outcomes such as estimated blood loss and length of hospital stay were assessed descriptively. Results: Three comparative observational cohorts met inclusion criteria. Intracorporeal neobladder reconstruction and robotic-assisted cystectomy demonstrated consistent reductions in transfusion rates and favourable trends in perioperative morbidity. In frail patient populations, robotic surgery showed reduced intraoperative burden without increased readmission or mortality. Ileal conduit diversion was associated with increased wound-related complications and infectious outcomes; however, these findings likely reflect baseline differences in patient frailty and selection. Rare-event sensitivity analyses confirmed directional consistency of treatment effects despite wide confidence intervals. Integration of absolute risk differences and NNT/NNH metrics provided clinically interpretable context for stratified outcomes. Conclusions: Minimally invasive and intracorporeal strategies following radical cystectomy may reduce perioperative burden, whereas diversion type primarily influences complication patterns rather than overall morbidity. A stratified analytical framework integrating relative and absolute effect measures may offer a more clinically meaningful approach to evaluating reconstructive strategies in heterogeneous surgical populations. Full article

Background/Objectives: Chronic subdural hematoma (cSDH) is an increasingly prevalent neurosurgical condition in the aging population. Burr hole craniotomy (BHC) with irrigation and postoperative drainage represents the evidence-based standard of care, yet recurrence rates remain substantial. Twist drill craniostomy (TDC), a minimally invasive bedside procedure performed under local anesthesia, offers theoretical advantages for frail patients but has been largely abandoned due to concerns regarding incomplete evacuation and recurrence. This study aimed to identify the predictors of a successful TDC outcome and to compare the recurrence rates between TDC and BHC. Methods: We performed a retrospective cohort study of consecutive patients undergoing surgical treatment for radiologically confirmed cSDH at RWTH Aachen University Hospital between 2015 and 2023. Hematoma morphology was classified using an extended CT-based architecture system and grouped into homogeneous, organized, sedimented, or subacute categories. The primary endpoint was recurrence requiring surgical reintervention. Multivariable logistic regression was used to identify independent predictors of recurrence among patients discharged after definitive TDC. Propensity score matching was performed to compare recurrence rates between TDC and BHC while adjusting for baseline demographic, clinical, and radiographic differences. Results: Among 178 patients initially treated with TDC, 56 (31.5%) were discharged without conversion to BHC. Late recurrence occurred in 26 of 56 patients (46.4%) treated definitively with TDC. In multivariable analysis, homogeneous hematoma architecture was the only independent predictor of recurrence (adjusted OR 4.48, 95% CI 1.10–22.07, p = 0.037). Propensity score matching yielded 48 well-balanced pairs of TDC and BHC patients. Recurrence rates remained significantly higher after TDC compared with BHC (42.6% vs. 17.0%, p = 0.012), as confirmed by conditional logistic regression (adjusted OR 3.20, 95% CI 1.17–8.73). Conclusions: Twist drill craniostomy may provide definitive treatment in carefully selected patients but is associated with substantially higher recurrence rates than burr hole craniotomy, particularly in homogeneous hematomas. Burr hole evacuation remains the preferred standard approach, while optimized drainage protocols and architecture-guided selection may define a limited role for TDC in high-risk patients. Full article

Background/objectives: Chronic kidney disease (CKD) affects approximately 800 million individuals worldwide and poses a growing health challenge. To support safer prescribing practices, our research group developed a renal risk medication quick guide (RRMQG), which provides recommendations for the 50 most prevalent renal risk medications (RRMs). This study explored the usefulness of implementing the RRMQG in Danish hospital settings. Methods: In this multicenter pilot study conducted across six Danish hospitals, 28 clinical pharmacists applied the RRMQG during medication reviews of frail, geriatric patients with renal impairment from May to October 2023. Useability was explored through structured surveys completed by the pharmacists. Results: Among 182 patients, 378 RRMs were detected, and 14% of these were associated with potential drug-related problems (DRPs). The RRMs were distributed across 35 of the 50 from the RRMQG, and patients received an average of two RRMs each. Most pharmacists found the RRMQG manageable for implementation in practice. Conclusions: The RRMQG was useful and manageable for implementation in practice in Danish hospitals, particularly due to its medication-specific recommendations. However, adjustments to the RRMQG may be beneficial by, for example, adding opioids or context-relevant medications to meet individual needs. Full article

Background and Objectives: Breast cancer surgery is increasingly performed in older patients with multimorbidity, in whom cardiovascular disease and frailty may substantially modify perioperative risk, including vulnerability to heart failure decompensation and other major medical complications. However, most available studies report global perioperative complication rates and composite medical endpoints, with heart failure events only rarely captured as dedicated outcomes, and operative technique, cardiovascular comorbidity, and frailty are often treated as separate domains rather than components of an integrated risk framework. Materials and Methods: We conducted a systematized narrative review with a structured literature search in PubMed/MEDLINE, Scopus, and Web of Science from inception to 31 January 2026, including original studies of adult patients undergoing breast-conserving surgery, mastectomy, and/or reconstruction that reported early postoperative outcomes in relation to comorbidities, cardiovascular risk, or frailty. Eligibility assessment, data extraction, and qualitative synthesis followed key PRISMA 2020 principles, and findings were organized into three prespecified domains: surgical complexity, cardiovascular vulnerability (including patients with heart failure where reported), and frailty. Results: Nineteen studies (retrospective cohorts, registry-based analyses, and large database studies, primarily ACS NSQIP) met inclusion criteria, encompassing diverse breast surgery populations, including elderly, metastatic, and reconstructive cohorts. Across datasets, escalation from breast-conserving surgery to mastectomy and then to increasingly complex reconstruction was associated with a stepwise increase in perioperative complications, reoperations, bleeding, and, in selected series, catastrophic events. Preexisting cardiovascular disease and systemic vascular pathology significantly amplified postoperative morbidity even in procedures considered low or intermediate cardiac risk, with signals that patients with underlying heart failure carry particularly heightened vulnerability, although HF-specific events were infrequently reported as separate endpoints. Frailty, mainly assessed using modified frailty indices, consistently emerged as a strong, age-independent predictor of 30-day complications, mortality, and readmissions across surgical types, including both breast-conserving and reconstructive procedures. Conclusions: Early postoperative outcomes after breast cancer surgery are associated with the interaction between surgical complexity, cardiovascular comorbidity (with limited HF-specific reporting), and frailty rather than by operative technique alone. In this context, our synthesis primarily reflects overall cardiovascular vulnerability in comorbid and frail patients, with heart failure risk inferred indirectly from the available data. These findings support a patient-centered, risk-adapted surgical strategy in which the extent and timing of surgery and reconstruction are tailored to each patient’s cardiovascular profile and frailty status, with preferential use of breast-conserving or less complex procedures in vulnerable individuals. Integrating standardized frailty assessment and cardio-oncologic evaluation into preoperative workflows, and prospectively validating this tri-axial framework in dedicated cohorts, may improve perioperative risk stratification and reduce the burden of postoperative medical complications in an aging breast cancer population. Full article

The progressive aging of the atrial fibrillation (AF) population, frequently characterized by high ischemic and bleeding risks, has led to a substantial increase in referrals for left atrial appendage occlusion (LAAO). The expansion of indications and the high procedural success rate of LAAO have further contributed to rising procedural volumes. However, this growth introduces important challenges: LAAO candidates are often elderly and frail, with increased anesthesia-related risks, and high-volume catheterization laboratories may face logistical constraints, particularly in centers without dedicated anesthesiology support. The current gold standard approach, transesophageal echocardiography (TEE) under general anesthesia (GA), ensures optimal imaging and procedural control but may increase procedural complexity and perioperative risks. In response, minimalist strategies are increasingly explored, targeting either the anesthetic protocol or the imaging modality. Conscious sedation (CS) protocols have been adopted to reduce anesthesia-related burden while maintaining TEE guidance. Alternatively, imaging-based strategies aim to replace TEE with less invasive modalities, including intracardiac echocardiography (ICE), transesophageal–intracardiac echocardiography (TE-ICE), and MicroTEE. Each approach presents specific advantages and limitations regarding safety, feasibility, operator expertise, and institutional resources. Taken together, these findings support a patient-centered approach to LAAO, whether traditional or minimalist, in which the choice of anesthetic strategy and echocardiographic guidance is driven by institutional resources, operator expertise, and individual patient characteristics rather than by expected differences in procedural or clinical efficacy. This review summarizes current evidence on minimalist LAAO pathways and discusses their role in achieving a tailored, resource-conscious procedural model. Full article

Background/Objectives: As mounting numbers of older people consider surgery, the importance of aligning treatments with patient values and goals is paramount. This has led to the growth of POPS (Perioperative care of Older Patients) services internationally and across Australia. An observational pilot evaluation of the Melbourne Health POPS service was conducted throughout 2022, with the aims of describing the population, measuring patient-reported outcomes and comparing postoperative outcomes to a matched historical cohort. Methods: Data were sourced from clinical review, electronic medical records and health intelligence. Patients who pursued surgery were matched 2:1 with a 2020 control cohort on up to 10 characteristics ranked on clinical judgement. Patient-reported outcomes were collected at 3 months post-surgery or at the clinic in consenting participants. Results: There were 128 participants, of whom 64 (50%) pursued non-surgical management. Participants were older (median 79 [13] years), frail (median CFS 5 [2]), and multimorbid (median CCI 5 [2.25]). Despite increased perioperative risk amongst the POPS surgical group (ASA-4 23.4% vs. 5.5%, p < 0.001), increased incidence of postoperative delirium (15% vs. 5.8%, p = 0.042) and ICU admission (21.7% vs. 7.5%, p = 0.006) compared to the control group, median length of stay was similar (4.3 [6.7] vs. 4.3 [5.1] days, p = 0.537). Patient-reported outcomes were similar between surgical and non-surgical POPS groups (90.7% vs. 88.1% would make the same surgical decision, p = 0.697). Conclusions: Patients attending POPS were multimorbid with geriatric syndromes and elevated perioperative risk. A high proportion pursued non-operative care. Patient-reported feedback was high with low decisional regret. Full article

Background: Sarcopenia is increasingly recognized as a prognostic factor in surgical populations. This study evaluated the association between cranial CT-based markers of sarcopenia and neurological outcomes in patients undergoing surgery for chronic subdural hematoma (CSDH). Methods: This retrospective case–control study included 82 patients who underwent surgery for unilateral CSDH. Demographic data, comorbidities, use of anticoagulant and antiplatelet therapy, postoperative complications and length of hospital stay were collected from patients’ medical records. Radiological parameters of sarcopenia, including temporal muscle thickness, temporal muscle area, and occipital fat pad thickness, as well as standard radiological features of CSDH, were measured preoperatively on the initial CT scan. Neurological outcome 3 months after surgery was assessed using the Glasgow Outcome Scale, with scores ≥ 4 defined as favourable and scores 1–3 as poor. Results: Demographic and clinical characteristics, including age, sex, comorbidities, hematoma thickness and intracranial midline shift, did not differ significantly between outcome groups. Temporal muscle thickness (4.7 vs. 2.8 mm, p < 0.001), temporal muscle area (160 vs. 106 mm², p = 0.04), and occipital fat pad thickness (4.7 vs. 3.4 mm, p = 0.04) were significantly greater in patients with favourable neurological outcomes. After corrections for age and comorbidities, multivariate logistic regression with temporal muscle thickness, area and density, temporal bone thickness and density, and occipital fat pad thickness demonstrated that temporal muscle thickness was the only independent predictor of good neurological recovery (OR 3.20, 95% CI 1.37–7.46, p = 0.007). ROC analysis showed good discriminatory power of temporal muscle thickness (AUC 0.812, 95% CI 0.695–0.930, p < 0.001), with a cut-off value of ≥3.37 mm for its ability to predict favourable neurological outcome. Conclusions: Temporal muscle thickness is a reliable, non-invasive imaging biomarker for predicting good neurological recovery after CSDH surgery and may aid in risk stratification, particularly in elderly or frail patients. Full article