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.

Laurence Johann Glancz,Michael Tin Chung Poon,Ian Craig Coulter,Paul Martin Brennan,Peter John Hutchinson,Angelos Georgiou Kolias

doi:10.1093/neuros/nyy366

Laurence Johann Glancz, Michael Tin Chung Poon + Show 4 more

Open Access

https://doi.org/10.1093/neuros/nyy366

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Abstract

BackgroundDrain insertion following chronic subdural hematoma (CSDH) evacuation improves patient outcomes.ObjectiveTo examine whether this is influenced by variation in drain location, positioning or duration of placement.MethodsWe 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.ResultsA 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).CONCLUSIONDrain 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.

Highlights

Drain insertion following chronic subdural hematoma (CSDH) evacuationCollaborative (BNTRC)improves patient outcomes
Patients from the cohort study who were transferred to an Neurosurgical Units (NSUs) and underwent primary burr-hole craniostomy (BHC) with drain placement for either unilateral or bilateral CSDH were included in this subgroup analysis
In our previous multicenter cohort study, we demonstrated that drain insertion was an important predictor of outcomes

Summary

BACKGROUND

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. This work was presented orally at the Autumn Society of British Neurological Surgeons’ Meeting, in Liverpool, United rates were comparable between subdural (7.7%; 41/533) and subgaleal (9.1%; 4/44) groups (P = .95). Recurrence rates were comparable between patients with postoperative drainage for 1 or Kingdom, on September 21, 2017. Ireland confirmed the benefit of drain insertion in terms of symptomatic CSDH recurrence requiring reoperation within 60 d of the index surgery.[4] that same study demonstrated significant variation in the details of surgical management of symptomatic CSDH between surgeons. DRAIN POSITION AND DURATION IN SURGERY FOR CSDH outcomes by performing a subgroup analysis of patients in the national audit

Participants and Study Settings

RESULTS

DISCUSSION

CONCLUSION

Disclosures