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

Greuter, Ladina; Lutz, Katharina; Fandino, Javier; Mariani, Luigi; Guzman, Raphael; Soleman, Jehuda (2020). Drain type after burr-hole drainage of chronic subdural hematoma in geriatric patients: a subanalysis of the cSDH-Drain randomized controlled trial. Neurosurgical focus, 49(4), E6. American Association of Neurological Surgeons 10.3171/2020.7.FOCUS20489

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OBJECTIVE

Chronic 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.

METHODS

The 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.

RESULTS

Patients ≥ 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.

CONCLUSIONS

The 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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery

UniBE Contributor:

Lutz, Katharina Sarah Jennifer

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1092-0684

Publisher:

American Association of Neurological Surgeons

Language:

English

Submitter:

Nicole Söll

Date Deposited:

12 Oct 2020 16:57

Last Modified:

12 Oct 2020 17:04

Publisher DOI:

10.3171/2020.7.FOCUS20489

PubMed ID:

33002868

Uncontrolled Keywords:

BHD = burr-hole drainage CAD = coronary artery disease CCI = Charlson Comorbidity Index GCS = Glasgow Coma Scale GOS = Glasgow Outcome Scale LOS = length of stay MLS = midline shift MWS = Markwalder score RCT = randomized controlled trial SDD = subdural drain SPD = subperiosteal drain burr-hole drainage cSDH = chronic subdural hematoma chronic subdural hematoma elderly patients geriatric mRS = modified Rankin Scale octogenarian recurrence subdural drain subperiosteal drain

BORIS DOI:

10.7892/boris.146937

URI:

https://boris.unibe.ch/id/eprint/146937

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