Fewer complications with bolt-connected than tunneled external ventricular drainage

Area of Science:

• Neurosurgery
• Medical Devices
• Patient Safety

Background:

• External ventricular drains (EVDs) are crucial in neurosurgery.
• Drain fixation techniques vary, impacting patient outcomes.
• Comparing bolt-connected EVD (BC-EVD) and tunneled EVD (T-EVD) is essential.

Purpose of the Study:

• To retrospectively compare complication rates between BC-EVD and T-EVD.
• To evaluate the incidence of unintended removal, obstruction, infection, CSF leakage, and mechanical issues.
• To determine the optimal EVD fixation technique for neurosurgical practice.

Main Methods:

• Retrospective analysis of 272 EVDs in 271 patients from 2009-2010.
• Data collected from two Danish neurosurgery departments (Odense and Aarhus).
• Patient files reviewed for EVD fixation type and specific complications.

Main Results:

• BC-EVD group had a significantly lower complication rate requiring reinsertion (6.5%) compared to T-EVD (40%).
• No significant difference in infection rates was observed between the two groups.
• The number needed to treat with BC-EVD to prevent one reinsertion complication is three.

Conclusions:

• Tunneled EVDs are associated with a high rate of complications requiring reinsertion.
• Bolt-connected EVD technique substantially reduces complication frequency.
• BC-EVDs are recommended for neurosurgical practice due to improved safety and reduced reintervention rates.