Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Box 430, 40530, Gothenburg, Sweden.
Department of Neurosurgery, Sahlgrenska University Hospital, Blå Stråket 5, 41345, Gothenburg, Sweden.
Acta Neurochir (Wien). 2023 Mar;165(3):711-715. doi: 10.1007/s00701-023-05511-y. Epub 2023 Feb 8.
It is well established that the use of a postoperative drain after chronic subdural hematoma surgery reduces recurrence rates, and it is common to use a postoperative drain for longer than 24 h. It is unclear whether this is superior to a shorter drainage time of less than 24 h. Our aim was to compare a postoperative drainage longer or shorter than 24 h after chronic subdural hematoma evacuation.
In this retrospective single centre study, 207 adult patients undergoing chronic subdural hematoma evacuation with a postoperative drainage longer (LDT-group) or shorter (SDT-group) than 24 h were compared regarding recurrence, mortality within 6 months and complications requiring hospital admission within 30 days. Length of hospital stay was also recorded. An active subgaleal drain was used. In addition to the retrospective cohort, we also studied the total volume drained per hour after cSDH surgery in a prospective cohort of 10 patients.
Recurrence occurred in 12/96 (12.5%) in the LDT-group and in 13/111 (11.7%) patients in the SDT-group (p = 0.15). There was no significant difference between groups regarding recurrence, complications or mortality. The prospective cohort showed that most of the drainage occurred within the first hours after surgery.
Our data show that a postoperative drainage duration of less than 24 h does not lead to an increase in recurrence, complications or mortality compared to a drainage time of more than 24 h. A shorter drainage duration (< 24 h) after cSDH surgery facilitated earlier mobilisation and shorter hospital stay.
术后引流在慢性硬脑膜下血肿手术后降低复发率已得到充分证实，术后引流时间超过 24 小时很常见。目前尚不清楚这是否优于更短的引流时间（少于 24 小时）。我们的目的是比较慢性硬脑膜下血肿清除术后引流时间超过或少于 24 小时的效果。
在这项回顾性单中心研究中，比较了 207 例成人慢性硬脑膜下血肿清除术后引流时间较长（LDT 组）或较短（SDT 组）的患者（LDT 组引流时间超过 24 小时，SDT 组引流时间少于 24 小时），比较了复发、6 个月内死亡率以及 30 天内需要住院治疗的并发症。记录了住院时间。使用了活动性皮下引流。除了回顾性队列研究，我们还在 10 例患者的前瞻性队列中研究了 cSDH 手术后每小时引流的总量。
LDT 组 12/96（12.5%）患者复发，SDT 组 13/111（11.7%）患者复发（p=0.15）。两组在复发、并发症或死亡率方面无显著差异。前瞻性队列研究显示，术后头几个小时内引流最多。
我们的数据表明，与引流时间超过 24 小时相比，术后引流时间少于 24 小时不会导致复发、并发症或死亡率增加。cSDH 手术后较短的引流时间（<24 小时）可以促进更早的活动和缩短住院时间。
