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When the Drain Hits the Brain.
Maria Kamenova1, Stefan Wanderer2, Patrick Lipps3
1Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland.
World Neurosurgery
|March 10, 2020
Summary
Subdural drain misplacement after chronic subdural hematoma drainage occurs in 15.8% of cases, leading to complications. Risk factors include anticoagulation and low GCS, impacting bleeding and hospitalization.
Area of Science:
- Neurosurgery
- Medical Devices
- Patient Safety
Background:
- Subdural drain (SDD) insertion post-burr-hole drainage for chronic subdural hematoma (cSDH) improves outcomes.
- However, data on SDD misplacement rates and associated complications are limited.
Purpose of the Study:
- To retrospectively analyze SDD misplacement rates and complications.
- To identify risk factors for misplacement and associated adverse events in cSDH patients.
Main Methods:
- Retrospective cohort analysis of 463 cSDH patients from two institutions.
- Evaluation of drain type (SDD vs. subperiosteal), misplacement rates, and complications.
- Multivariate analysis to identify risk factors for SDD misplacement and complications.
Main Results:
- SDD was used in 62.6% of patients; misplacement occurred in 15.8%.
- Misplacement led to iatrogenic bleeding (6.9%) and neurological symptoms (12.3%).
- Anticoagulation (VKA, other oral) and low GCS were risk factors for misplacement; misplacement correlated with bleeding and longer hospitalization.
Conclusions:
- Subdural drain misplacement is a significant issue in cSDH treatment.
- Misplacement increases the risk of complications, bleeding, and prolonged hospitalization.
- Identifying and mitigating risk factors for SDD misplacement is crucial for patient safety.
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