Abstract
Introduction: Hydrocephalus is a common complication following aneurysmal subarachnoid hemorrhage (aSAH) and is usually treated with external ventricular drain (EVD). However, there is no consensus on EVD weaning process and duration of cerebrospinal fluid (CSF) drainage. We aimed to determine association of EVD duration and outcomes. Methods: We performed a retrospective cohort study of consecutive patients with aSAH who were admitted to an academic referral center between 2016 and 2021. Binary logistic regression was used to test the association of EVD duration (continuous variable) and outcomes including functional outcome defined as modified Rankin scale of 4-6 at 3 months after discharge and requirement for ventriculoperitoneal shunt (VPS) placement. Multiple linear regression analysis was used to test the association of EVD duration and hospital length of stay (both continuous variables) Results: Of 316 patients with aSAH, 253 patients received external ventricular drain (EVD) on admission for symptomatic hydrocephalus and we included survivors (n=204) in final analysis. (mean age 57.9 years (SD 13.8), 62% female, 71% white). VPS was placed in 15% (30/204) prior to hospital discharge. Duration of EVD was longer in patients with worse functional outcome (median 18 days [IQR 13.5-23] vs 12 days [IQR 8-19); p=0.006). EVD wean was interrupted in 39% of survivors (80/204) due to persistent hydrocephalus (61%) and asymptomatic vasospasm (19%) based on transcranial Doppler criteria. Longer EVD duration was associated with higher VPS requirement (odds ratio 1.17 per day, 95% CI 1.09-1.26; p<0.001) after adjustment for age, aneurysm related factors, Hunt and Hess grades, modified Fisher scales and delayed cerebral ischemia. EVD related complications such as infections (2%) and tract hemorrhage (9%) were non-significantly higher in patients with longer EVD duration. (p=0.070) Longer EVD duration was associated with longer hospital length of stay (0.88 more days, 95% CI 0.73-1.04; p<0.001) independent of aSAH complications. Conclusions: Longer EVD duration can be associated with worse outcomes and higher need for VPS placement and longer hospital length of stay. Further studies are needed to justify early VPS placement in selected patients.
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