Does Drain Position and Duration Influence Outcomes in Patients Undergoing Burr-Hole Evacuation of Chronic Subdural Hematoma? Lessons from a UK Multicenter Prospective Cohort Study.


Type
Article
Change log
Authors
Glancz, Laurence Johann 
Poon, Michael Tin Chung 
Coulter, Ian Craig 
Hutchinson, Peter John 
Kolias, Angelos Georgiou 
Abstract

BACKGROUND: Drain insertion following chronic subdural hematoma (CSDH) evacuation improves patient outcomes. OBJECTIVE: To examine whether this is influenced by variation in drain location, positioning or duration of placement. METHODS: We performed a subgroup analysis of a previously reported multicenter, prospective cohort study of CSDH patients performed between May 2013 and January 2014. Data were analyzed relating drain location (subdural or subgaleal), position (through a frontal or parietal burr hole), and duration of insertion, to outcomes in patients aged >16 yr undergoing burr-hole drainage of primary CSDH. Primary outcomes comprised modified Rankin scale (mRS) at discharge and symptomatic recurrence requiring redrainage within 60 d. RESULTS: A total of 577 patients were analyzed. The recurrence rate of 6.7% (12/160) in the frontal subdural drain group was comparable to 8.8% (30/343) in the parietal subdural drain group. Only 44/577 (7.6%) patients underwent subgaleal drain insertion. Recurrence rates were comparable between subdural (7.7%; 41/533) and subgaleal (9.1%; 4/44) groups (P = .95). We found no significant differences in discharge mRS between these groups. Recurrence rates were comparable between patients with postoperative drainage for 1 or 2 d, 6.4% and 8.4%, respectively (P = .44). There was no significant difference in mRS scores between these 2 groups (P = .56). CONCLUSION: Drain insertion after CSDH drainage is important, but position (subgaleal or subdural) and duration did not appear to influence recurrence rate or clinical outcomes. Similarly, drain location did not influence recurrence rate nor outcomes where both parietal and frontal burr holes were made. Further prospective cohort studies or randomized controlled trials could provide further clarification.

Description
Keywords
Burr-hole craniostomy, Chronic subdural hematoma, Drains, Outcome, Recurrence, Adult, Aged, Drainage, Female, Hematoma, Subdural, Chronic, Humans, Male, Middle Aged, Multicenter Studies as Topic, Postoperative Period, Prospective Studies, Recurrence, Treatment Outcome, Trephining, United Kingdom
Journal Title
Neurosurgery
Conference Name
Journal ISSN
0148-396X
1524-4040
Volume Title
85
Publisher
Ovid Technologies (Wolters Kluwer Health)
Sponsorship
European Commission (602150)
Medical Research Council (G0601025)
Medical Research Council (G1002277)
Medical Research Council (G0600986)
Medical Research Council (G9439390)
NETSCC (None)
NETSCC (None)
TCC (None)