TY - JOUR
T1 - Predictors of revision surgery after bedside subdural drain placement for chronic subdural hematomas
AU - Mamaril-Davis, James C.
AU - Avila, Mauricio J.
AU - Burket, Aaron
AU - Aguilar-Salinas, Pedro
AU - Weinand, Martin
AU - Dumont, Travis M.
N1 - Funding Information:
We would like to acknowledge Joe Arnett, senior graphic designer, from the Biocommunications Department at the University of Arizona College of Medicine – Tucson for his diligent artwork with Fig. 1 and 2 in this manuscript. We also thank statistician Mark Borgstrom, PhD, in the Statistical Support for Research Computing Department at The University of Arizona for reviewing the methods and results of this study.
Publisher Copyright:
© 2023 Elsevier B.V.
PY - 2023/8
Y1 - 2023/8
N2 - Background and objective: For chronic subdural hematoma (cSDH), bedside subdural drains (SDD) provide a useful alternative to more invasive neurosurgical techniques, including evacuation through multiple burr holes or formal craniotomy. However, no scale currently exists adequately predicting SDD candidacy or treatment response. The present study sought to characterize predictors of revision surgery after initial treatment with bedside SDD for cSDH. Methods: We conducted a retrospective case control study of cSDH patients treated with bedside SDD at a level one trauma center between 2018 and 2022. Binomial regression was used to compare SDD patients and generate odds ratios associated with revision surgery, which were compared using a binary random effects model. Results: Ninety six cSDH patients were included, of whom 13 (13.5%) required a revision surgery after initial treatment failure with bedside SDD. Patients requiring revision surgery demonstrated an increased male predominance (84.6% vs. 69.9% of SDD patients not requiring revision surgery), tended to be younger (67.8 vs. 70.5 years) with a greater body mass index (28.7 vs. 25.6 kg/m2), and have a lower Glasgow Coma Scale (GCS) score on presentation of 12.5 (versus 14). Patients with an initial GCS score less than 13 (OR 11.0 95% CI 2.8 – 43.3), midline shift greater than 10 mm on CT (OR 6.5 95% CI 1.7 – 25.7), or duration of SDD placement longer than 3 days (OR 10.5 95% CI 2.6 – 41.9) demonstrated a greater likelihood of needing a revision surgery after initial treatment with bedside SDD. Conclusion: Among patients treated with SDD, we identified 3 independent factors predicting the need for revision surgery: GCS score, midline shift, and duration of drain placement. Craniotomy may be favored over bedside SDD in patients presenting with a GCS score less than 13 or midline shift greater than 10 mm and for SDD patients demonstrating inadequate clinical response after 3 days.
AB - Background and objective: For chronic subdural hematoma (cSDH), bedside subdural drains (SDD) provide a useful alternative to more invasive neurosurgical techniques, including evacuation through multiple burr holes or formal craniotomy. However, no scale currently exists adequately predicting SDD candidacy or treatment response. The present study sought to characterize predictors of revision surgery after initial treatment with bedside SDD for cSDH. Methods: We conducted a retrospective case control study of cSDH patients treated with bedside SDD at a level one trauma center between 2018 and 2022. Binomial regression was used to compare SDD patients and generate odds ratios associated with revision surgery, which were compared using a binary random effects model. Results: Ninety six cSDH patients were included, of whom 13 (13.5%) required a revision surgery after initial treatment failure with bedside SDD. Patients requiring revision surgery demonstrated an increased male predominance (84.6% vs. 69.9% of SDD patients not requiring revision surgery), tended to be younger (67.8 vs. 70.5 years) with a greater body mass index (28.7 vs. 25.6 kg/m2), and have a lower Glasgow Coma Scale (GCS) score on presentation of 12.5 (versus 14). Patients with an initial GCS score less than 13 (OR 11.0 95% CI 2.8 – 43.3), midline shift greater than 10 mm on CT (OR 6.5 95% CI 1.7 – 25.7), or duration of SDD placement longer than 3 days (OR 10.5 95% CI 2.6 – 41.9) demonstrated a greater likelihood of needing a revision surgery after initial treatment with bedside SDD. Conclusion: Among patients treated with SDD, we identified 3 independent factors predicting the need for revision surgery: GCS score, midline shift, and duration of drain placement. Craniotomy may be favored over bedside SDD in patients presenting with a GCS score less than 13 or midline shift greater than 10 mm and for SDD patients demonstrating inadequate clinical response after 3 days.
KW - Chronic subdural hematoma
KW - GCS
KW - Midline shift
KW - SDD
KW - Subdural drain
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U2 - 10.1016/j.clineuro.2023.107836
DO - 10.1016/j.clineuro.2023.107836
M3 - Article
C2 - 37336052
AN - SCOPUS:85162052724
SN - 0303-8467
VL - 231
JO - Clinical Neurology and Neurosurgery
JF - Clinical Neurology and Neurosurgery
M1 - 107836
ER -