Predictors of acute intracranial hemorrhage and recurrence of chronic subdural hematoma following burr hole drainage

Abstract Objective To investigate predictors of postoperative acute intracranial hemorrhage (AIH) and recurrence of chronic subdural hematoma (CSDH) after burr hole drainage.MethodsA multicenter retrospective study of patients who underwent burr hole drainage for CSDH between January 2013 and March 2019. Univariate and multiple logistic regression analyses were performed to determine the relationship between CSDH recurrence and postoperative AIH and clinical, radiological, and surgical variables. Results A total of 456 CSDH patients (361 males, 95 females) were enrolled in the study. The median (IQR) age was 68 (61–77) years (range: 8–98 years). CSDH recurrence occurred in 63 patients (56 males, seven females), with a recurrence rate of 13.8%. The median time interval between initial burr hole drainage and recurrence was 37 (27–46) days (range: 12–180 days). Postoperative AIH developed in 23 patients (15 males, eight females), with an incidence of 5.0%. The median time interval between initial burr hole drainage and postoperative AIH was 4 (2–6) days (range: 1–10 days). Bilateral hematoma, hyperdense hematoma and anticoagulant drug use were independent predictors of recurrence in the multiple logistic regression analyses. Preoperative headache was an independent risk factor of postoperative AIH in the multiple logistic regression analyses, however, intraoperative irrigation reduced the incidence of postoperative AIH. Conclusions This study found that bilateral hematoma, hyperdense hematoma and anticoagulant drug use were independently associated with CSDH recurrence. Clinical presentation of headache was the strongest predictor of postoperative AIH, and intraoperative irrigation decreased the incidence of postoperative AIH.

Download Full-text

Predictors of acute intracranial hemorrhage and recurrence of chronic subdural hematoma following burr hole drainage

10.21203/rs.2.19037/v2 ◽

2020 ◽

Author(s):

FuMei Chen ◽

Ke Wang ◽

KangLi Xu ◽

Li Wang ◽

TianXiang Zhan ◽

...

Keyword(s):

Logistic Regression ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Burr Hole ◽

Time Interval ◽

Multiple Logistic Regression ◽

Regression Analyses ◽

Anticoagulant Drug ◽

The Mean ◽

Mean Time

Abstract Objective To investigate predictors of postoperative acute intracranial hemorrhage (AIH) and recurrence of chronic subdural hematoma (CSDH) after burr hole drainage. Methods A multicenter retrospective study of patients who underwent burr hole drainage for CSDH between January 2013 and March 2019. Results A total of 448 CSDH patients were enrolled in the study. CSDH recurrence occurred in 60 patients, with a recurrence rate of 13.4%. The mean time interval between initial burr hole drainage and recurrence was 40.8±28.3 days. Postoperative AIH developed in 23 patients, with an incidence of 5.1%. The mean time interval between initial burr hole drainage and postoperative AIH was 4.7±2.9 days. Bilateral hematoma, hyperdense hematoma and anticoagulant drug use were independent predictors of recurrence in the multiple logistic regression analyses. Preoperative headache was an independent risk factor of postoperative AIH in the multiple logistic regression analyses, however, intraoperative irrigation reduced the incidence of postoperative AIH. Conclusions This study found that bilateral hematoma, hyperdense hematoma and anticoagulant drug use were independently associated with CSDH recurrence. Clinical presentation of headache was the strongest predictor of postoperative AIH, and intraoperative irrigation decreased the incidence of postoperative AIH.

Download Full-text

Predictors of acute intracranial hemorrhage and recurrence of chronic subdural hematoma following burr hole drainage

10.21203/rs.2.19037/v3 ◽

2020 ◽

Author(s):

FuMei Chen ◽

Ke Wang ◽

KangLi Xu ◽

Li Wang ◽

TianXiang Zhan ◽

...

Keyword(s):

Logistic Regression ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Burr Hole ◽

Time Interval ◽

Multiple Logistic Regression ◽

Regression Analyses ◽

Anticoagulant Drug ◽

The Mean ◽

Mean Time

Abstract Background To investigate predictors of postoperative acute intracranial hemorrhage (AIH) and recurrence of chronic subdural hematoma (CSDH) after burr hole drainage. Methods A multicenter retrospective study of patients who underwent burr hole drainage for CSDH between January 2013 and March 2019. Results A total of 448 CSDH patients were enrolled in the study. CSDH recurrence occurred in 60 patients, with a recurrence rate of 13.4%. The mean time interval between initial burr hole drainage and recurrence was 40.8±28.3 days. Postoperative AIH developed in 23 patients, with an incidence of 5.1%. The mean time interval between initial burr hole drainage and postoperative AIH was 4.7±2.9 days. Bilateral hematoma, hyperdense hematoma and anticoagulant drug use were independent predictors of recurrence in the multiple logistic regression analyses. Preoperative headache was an independent risk factor of postoperative AIH in the multiple logistic regression analyses, however, intraoperative irrigation reduced the incidence of postoperative AIH. Conclusions This study found that bilateral hematoma, hyperdense hematoma and anticoagulant drug use were independently associated with CSDH recurrence. Clinical presentation of headache was the strongest predictor of postoperative AIH, and intraoperative irrigation decreased the incidence of postoperative AIH.

Download Full-text

Impact of Time Interval between Trauma Onset and Burr Hole Surgery on Recurrence of Late Subacute or Chronic Subdural Hematoma

Journal of Korean Neurosurgical Society ◽

10.3340/jkns.2016.59.5.498 ◽

2016 ◽

Vol 59 (5) ◽

pp. 498

Author(s):

Dae-in Kim ◽

Jae-hoon Kim ◽

Hee-in Kang ◽

Byung-gwan Moon ◽

Joo-seung Kim ◽

...

Keyword(s):

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Burr Hole ◽

Time Interval

Download Full-text

Drain type after burr-hole drainage of chronic subdural hematoma in geriatric patients: a subanalysis of the cSDH-Drain randomized controlled trial

Neurosurgical FOCUS ◽

10.3171/2020.7.focus20489 ◽

2020 ◽

Vol 49 (4) ◽

pp. E6

Author(s):

Ladina Greuter ◽

Katharina Lutz ◽

Javier Fandino ◽

Luigi Mariani ◽

Raphael Guzman ◽

...

Keyword(s):

Logistic Regression ◽

Clinical Outcome ◽

Elderly Patients ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Burr Hole ◽

Recurrence Rates ◽

Patient Age ◽

Post Hoc Analysis ◽

Post Hoc

OBJECTIVEChronic subdural hematoma (cSDH) occurs more frequently in elderly patients, while older patient age is associated with worse postoperative outcome following burr-hole drainage (BHD) of cSDH. The cSDH-Drain trial showed comparable recurrence rates after BHD and placement of either a subperiosteal drain (SPD) or subdural drain (SDD). Additionally, an SPD showed a significantly lower rate of infections as well as iatrogenic parenchymal injuries through drain misplacement. This post hoc analysis aims to compare recurrence rates and clinical outcomes following BHD of cSDH and the placement of SPDs or SDDs in elderly patients.METHODSThe study included 104 patients (47.3%) 80 years of age and older from the 220 patients recruited in the preceding cSDH-Drain trial. SPDs and SDDs were compared with regard to recurrence rate, morbidity, mortality, and clinical outcome. A post hoc analysis using logistic regression, comparing the outcome measurements for patients < 80 and ≥ 80 years old in a univariate analysis and stratified for drain type, was further completed.RESULTSPatients ≥ 80 years of age treated with an SDD showed higher recurrence rates (12.8%) compared with those treated with an SPD (8.2%), without a significant difference (p = 0.46). Significantly higher drain misplacement rates were observed for patients older than 80 years and treated with an SDD compared with an SPD (0% vs 20%, p = 0.01). Comparing patients older than 80 years to younger patients, significantly higher overall mortality (15.4% vs 5.2%, p = 0.012), 30-day mortality (3.8% vs 0%, p = 0.033), and surgical mortality (2.9% vs 1.7%, p = 0.034) rates were observed. Clinical outcome at the 12-month follow-up was significantly worse for patients ≥ 80 years old, and logistic regression showed a significant association of age with outcome, while drain type had no association with outcome.CONCLUSIONSThe initial findings of the cSDH-Drain trial and the findings of this subanalysis suggest that SPD may be warranted in elderly patients. As opposed to drain type, patient age (> 80 years) was significantly associated with worse outcome, as well as higher morbidity and mortality rates.

Download Full-text