Assessment of drainage techniques for evacuation of chronic subdural hematoma: a consecutive population-based comparative cohort study

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  • 1 Department of Clinical Neuroscience, Karolinska Institutet, and Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden;
  • 2 Department of Neurosurgery, University Hospital of North Norway, Tromsø, Norway;
  • 3 Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway;
  • 4 Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway;
  • 5 Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden;
  • 6 Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden; and
  • 7 Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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OBJECTIVE

Surgery for chronic subdural hematoma (CSDH) is one of the most common neurosurgical procedures. The benefit of postoperative passive subdural drainage compared with no drains has been established, but other drainage techniques are common, and their effectiveness compared with passive subdural drains remains unknown.

METHODS

In Scandinavian population-based cohorts the authors conducted a consecutive, parallel cohort study to compare different drainage techniques. The techniques used were continuous irrigation and drainage (CID cohort, n = 166), passive subdural drainage (PD cohort, n = 330), and active subgaleal drainage (AD cohort, n = 764). The primary end point was recurrence in need of reoperation within 6 months of index surgery. Secondary end points were complications, perioperative mortality, and overall survival. The analyses were based on direct regional comparison (i.e., surgical strategy).

RESULTS

Recurrence in need of surgery was observed in 18 patients (10.8%) in the CID cohort, in 66 patients (20.0%) in the PD cohort, and in 85 patients (11.1%) in the AD cohort (p < 0.001). Complications were more common in the CID cohort (14.5%) compared with the PD (7.3%) and AD (8.1%) cohorts (p = 0.019). Perioperative mortality rates were similar between cohorts (p = 0.621). There were some differences in baseline and treatment characteristics possibly interfering with the above-mentioned results. However, after adjusting for differences in baseline and treatment characteristics in a regression model, the drainage techniques were still significantly associated with clinical outcome (p < 0.001 for recurrence, p = 0.017 for complications).

CONCLUSIONS

Compared with the AD cohort, more recurrences were observed in the PD cohort and more complications in the CID cohort, also after adjustment for differences at baseline. Although the authors cannot exclude unmeasured confounding factors when comparing centers, AD appears superior to the more common PD.

Clinical trial registration no.: NCT01930617 (clinicaltrials.gov)

ABBREVIATIONS AD = active subgaleal drain; CCI = Charlson Comorbidity Index; CI = confidence interval; CID = continuous irrigation and drainage; CSDH = chronic subdural hematoma; HR = hazard ratio; PD = passive subdural drain; RCT = randomized controlled trial.

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Contributor Notes

Correspondence Jiri Bartek Jr., Department of Neurosurgery, Karolinska University Hospital, Stockholm 17176, Sweden. email: jiri.bartek@karolinska.se.

INCLUDE WHEN CITING Published online June 23, 2017; DOI: 10.3171/2016.12.JNS161713.

Drs. Sjåvik and Bartek contributed equally to this work.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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