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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.

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cam.issuedOnline2019-10
dc.contributor.authorGlancz, Laurence Johann
dc.contributor.authorPoon, Michael Tin Chung
dc.contributor.authorCoulter, Ian Craig
dc.contributor.authorHutchinson, Peter John
dc.contributor.authorKolias, Angelos Georgiou
dc.contributor.authorBrennan, Paul Martin
dc.contributor.authorBritish Neurosurgical Trainee Research Collaborative (BNTRC)
dc.contributor.orcidHutchinson, Peter [0000-0002-2796-1835]
dc.contributor.orcidKolias, Angelos [0000-0003-3992-0587]
dc.date.accessioned2018-12-18T00:31:05Z
dc.date.available2018-12-18T00:31:05Z
dc.date.issued2019-10-01
dc.description.abstractBACKGROUND: 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.
dc.format.mediumPrint
dc.identifier.doi10.17863/CAM.34354
dc.identifier.eissn1524-4040
dc.identifier.issn0148-396X
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/287044
dc.languageeng
dc.language.isoeng
dc.publisherOvid Technologies (Wolters Kluwer Health)
dc.publisher.urlhttp://dx.doi.org/10.1093/neuros/nyy366
dc.rightsAttribution 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectBurr-hole craniostomy
dc.subjectChronic subdural hematoma
dc.subjectDrains
dc.subjectOutcome
dc.subjectRecurrence
dc.subjectAdult
dc.subjectAged
dc.subjectDrainage
dc.subjectFemale
dc.subjectHematoma, Subdural, Chronic
dc.subjectHumans
dc.subjectMale
dc.subjectMiddle Aged
dc.subjectMulticenter Studies as Topic
dc.subjectPostoperative Period
dc.subjectProspective Studies
dc.subjectRecurrence
dc.subjectTreatment Outcome
dc.subjectTrephining
dc.subjectUnited Kingdom
dc.titleDoes Drain Position and Duration Influence Outcomes in Patients Undergoing Burr-Hole Evacuation of Chronic Subdural Hematoma? Lessons from a UK Multicenter Prospective Cohort Study.
dc.typeArticle
dcterms.dateAccepted2018-07-14
prism.endingPage493
prism.issueIdentifier4
prism.publicationDate2019
prism.publicationNameNeurosurgery
prism.startingPage486
prism.volume85
pubs.funder-project-idEuropean Commission (602150)
pubs.funder-project-idMedical Research Council (G0601025)
pubs.funder-project-idMedical Research Council (G1002277)
pubs.funder-project-idMedical Research Council (G0600986)
pubs.funder-project-idMedical Research Council (G9439390)
pubs.funder-project-idNETSCC (None)
pubs.funder-project-idNETSCC (None)
pubs.funder-project-idTCC (None)
pubs.funder-project-idMedical Research Council (G0600986/1)
pubs.funder-project-idMedical Research Council (G1002277/1)
rioxxterms.licenseref.startdate2019-10
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.typeJournal Article/Review
rioxxterms.versionVoR
rioxxterms.versionofrecord10.1093/neuros/nyy366

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