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Time to and possible risk factors for recurrence after burr-hole drainage of chronic subdural hematoma - a subanalysis of the cSDH-Drain RCT
EANS Academy. Lutz K. Sep 27, 2019; 275961; EP05057
Abstract
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Objective: To analyze the difference in time to recurrence and possible risk factors for recurrence after burr-hole drainage of cSDH and placement of a subperiosteal (SPD) or subdural drain (SDD).
Methods: This subanalysis included 220 patients from the preceding cSDH-Drain trial, where the recurrence rates of surgically drained cSDH after placement of an SPD or SDD were compared. Time to recurrence was calculated for all patients and compared within the two groups using an univariate cox-proportional hazards model. Possible pre-, intra- and postoperative risk factors for recurrence were assessed for all patients and within the two groups through univariate and multivariate analysis.
Results: The median time to recurrence was 22.5 days (IQR 9.25 - 52 days, range 0-81 days) showing no difference between the two groups. Larger residual hematoma cavity on CT at 24 hours (p=0.019), lower GOS at release (p=0.007) and lower GCS at 24 hours (p=0.037) showed a significant association with recurrence rates on univariate analysis. On multivariate analysis larger residual hematoma cavity (OR 1.10, CI: 1.01; 1.21; p=0.03) was the only significant risk factor influencing recurrence. When comparing the risk factors within the two groups, larger residual hematoma cavity and lower GOS at release was an indicator for recurrence, only in the SDD group.
Conclusion: Time to recurrence did not differ significantly between the two drain types, while patients with larger residual hematoma cavities and lower GOS at release were associated with higher recurrence rates. However, the drain type used in patients with large preoperative hematomas or large residual hematoma cavities had no effect on recurrence rates.
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