Påverkar dränagetiden vid operativ behandling av kroniska subduralhematom återfallsrisken?

Abstract

Abstract Does the recurrence rate in Chronic subdural hematoma vary comparing longer and shorter duration of drainage? Authors: Sebastian Möller, Medical Student, Supervisor: Katrin Rabie, MD & PhD. Dept. Neurosurgery, Sahlgrenska University Hospital, Gothenburg University, Gothenburg, Sweden. Background: Chronic subdural hematoma (CSDH) is a common intracranial haemorrhage between the dural sheet and the arachnoid membrane and usually presents in the elderly. The origin is multifactorial and evolving mechanism include trauma and tearing of bridging vein, inflammatory response, angiogenesis and fibrinolysis. The role of post operative drainage in preventing recurrence is well established. However, there is a lack of evidence regarding the duration of drainage. The purpose of this study is to compare recurrence rates in two centres, one with 12 and the other with 24-hour postoperative drainage. Methods: A retrospective analysis of patients operated in Sahlgrenska University Hospital between 2011 and 2016 was performed. 800 patients were operated for CSDH out of which 94 were excluded based on our exclusion criteria leaving 706 patients in the study. 1260 patient were analysed respectively at Karolinska university hospital. Clinical data were obtained through chart review. Results: Our preliminary results show a significant difference (P-value<0.001) in overall recurrence rate between the two centres. Sahlgrenska University Hospital had shorter duration of drainage and a lower recurrence rate (9.3%). Karolinska University Hospital had a 24-hour duration of drainage and an overall recurrence rate of 13.4%. Conclusion: This study indicates that there is no additional preventive purpose in using longer drainage duration. On the contrary, patient with shorter duration of drainage had a significantly (P-value<0.001) lower overall recurrence rate (9.3%) compared with longer duration rates (13.4%). This could provide a faster mobilization time for patient undergoing surgery for CSDH. However, the results are preliminary and further research is needed to determine the difference in recurrence rate depending on duration of drainage.