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Passive or active drainage system for chronic subdural haematoma-a single-center retrospective follow-up study
Paulina Majewska1,2, Mattis A Madsbu3,4, Lisa Millgård Sagberg3,5
1Department of Neurosurgery, St. Olav's University Hospital, Trondheim, Norway. plmajewska@gmail.com.
Insights
Switching to active subgaleal drainage for chronic subdural hematoma (CSDH) did not reduce reoperation rates. However, this change in practice significantly decreased operative time for CSDH treatment.
Area of Science:
- Neurosurgery
- Surgical Techniques
- Clinical Outcomes
Background:
- Postoperative drainage is standard for chronic subdural hematoma (CSDH).
- Previous multi-center study suggested active subgaleal drainage (ASD) superior to passive subdural drainage (PSD) for CSDH.
- Clinical practice shifted to ASD based on prior findings.
Purpose of the Study:
- To evaluate the impact of switching from PSD to ASD on CSDH reoperation rates.
- To assess changes in complication rates following the drainage system conversion.
Main Methods:
- Single-center cohort study comparing two periods: PSD vs. ASD.
- Analysis of reoperation rates for recurrent same-sided CSDH.
- Comparison of postoperative complication rates between the two drainage systems.
Main Results:
- No significant difference in reoperation rates between PSD (21.6%) and ASD (18.0%) groups (p=0.275).
- No statistical difference in serious complication rates between the groups.
- Significantly shorter operating time for ASD (32.8 min) compared to PSD (47.6 min) (p<0.001).
Conclusions:
- Conversion to active subgaleal drainage did not significantly reduce CSDH reoperation rates in this center.
- Active subgaleal drainage offers a significant advantage by reducing surgical time.
- Further investigation may be needed to understand drainage system efficacy in CSDH management.
Background:
Postoperative drainage systems have become a standard treatment for chronic subdural hematoma (CSDH). We previously compared treatment results from three Scandinavian centers using three different postoperative drainage systems and concluded that the active subgaleal drainage was associated with lower recurrence and complication rates than the passive subdural drainage. We consequently changed clinical practice from using the passive subdural drainage to the active subgaleal drainage.
Objective:
The aim of the present study was to assess a potential change in reoperation rates for CSDH after conversion to the active subgaleal drainage.
Methods:
This single-center cohort study compared the reoperation rates for recurrent same-sided CSDH and postoperative complication rates between patients treated during two study periods (passive subdural drainage cohort versus active subgaleal drainage cohort).
Results:
In total, 594 patients were included in the study. We found no significant difference in reoperation rates between the passive subdural drain group and the active subgaleal drain group (21.6%, 95% CI 17.5-26.4% vs. 18.0%, 95% CI 13.8-23.2%; p = 0.275). There was no statistical difference in the rate of serious complications between the groups. The operating time was significantly shorter for patients operated with the active subgaleal drain than patients with the passive subdural drain (32.8 min, 95% CI 31.2-34.5 min vs. 47.6 min, 95% CI 44.7-50.4 min; p < 0.001).
Conclusions:
Conversion from the passive subdural to the active subgaleal drainage did not result in a clear reduction of reoperation rates for CSDH in our center.
