Lodewijkx Roger, Holl Dana Catharina, Slot Kari-Anne Mariam, Volovici Victor, Dirven Clemens Maria Franciscus, Dammers Ruben, Vandertop William Peter, Verbaan Dagmar
Department of Neurosurgery, Neurosurgical Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus University Medical Center, Rotterdam, The Netherlands.
J Neurotrauma. 2021 Sep 15;38(18):2572-2579. doi: 10.1089/neu.2020.7564. Epub 2021 May 20.
The role of steroids as an adjunct to surgery for chronic subdural hematoma (cSDH) remains unclear. We evaluated the effect of steroids as an adjunct to surgery on recurrence rates, complications, and mortality. We retrospectively collected data of 525 patients operated on for cSDH between January 2010 and April 2015 at the Amsterdam University Medical Centers and Erasmus Medical Center Rotterdam. Data from patients with and without steroid use as an adjunct to surgery were obtained from medical records and compared using the chi-square test, independent-samples -test, and Mann-Whitney U test, where applicable. Associations between adjuvant steroid use and complications were analyzed with univariable (penalized likelihood) logistic regression analysis. Multi-variate logistic regression was performed to analyze the influence of adjuvant steroid use on recurrence. Propensity-score matching was used to assemble a cohort of patients with similar baseline characteristics. Two hundred seventy-eight of the 525 patients (53%) were treated with adjuvant steroids. Surgery for recurrences occurred less in patients of the steroid group (9% vs. 14%; odds ratio [OR] 0.57; 95% confidence interval [CI], 0.33-0.99), but the effect was not significant after correction for confounders (adjusted aOR, 0.59; 95% CI, 0.33-1.05). In the steroid group, delirium (10% vs. 3%; OR, 3.99; 95% CI, 1.72-9.29) and dysregulated glucose levels occurred more frequently (2% vs. 0%; OR, 11.81; 95% CI, 1.38-1542.79), but multi-variate analysis was not possible. After propensity-score matching, McNemar's chi-square test showed that adjuvant steroid use was not significantly associated with recurrence rate ( = 0.10). Steroids as an adjunct to surgery in patients with cSDH did not have a favorable effect on the recurrence rate in our data after controlling for confounders.
类固醇作为慢性硬膜下血肿（cSDH）手术辅助治疗手段的作用仍不明确。我们评估了类固醇作为手术辅助手段对复发率、并发症和死亡率的影响。我们回顾性收集了2010年1月至2015年4月期间在阿姆斯特丹大学医学中心和鹿特丹伊拉斯姆斯医学中心接受cSDH手术的525例患者的数据。从病历中获取了使用和未使用类固醇作为手术辅助手段的患者数据，并在适用时使用卡方检验、独立样本t检验和曼-惠特尼U检验进行比较。使用单变量（惩罚似然）逻辑回归分析辅助类固醇使用与并发症之间的关联。进行多变量逻辑回归分析以分析辅助类固醇使用对复发的影响。倾向评分匹配用于组建一组具有相似基线特征的患者。525例患者中有278例（53%）接受了辅助类固醇治疗。类固醇组患者的复发手术发生率较低（9%对14%；比值比[OR]0.57；95%置信区间[CI]，0.33 - 0.99），但在校正混杂因素后效果不显著（调整后的aOR，0.59；95% CI，0.33 - 1.05）。在类固醇组中，谵妄（10%对3%；OR，3.99；95% CI，1.72 - 9.29）和血糖水平失调更频繁发生（2%对0%；OR，11.81；95% CI，1.38 - 1542.79），但无法进行多变量分析。倾向评分匹配后，McNemar卡方检验显示辅助类固醇使用与复发率无显著关联（P = 0.10）。在我们的数据中，在控制混杂因素后，类固醇作为cSDH患者手术的辅助手段对复发率没有有利影响。
