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Active Versus Passive Drainage Systems for Subdural Hematomas: A Systematic Review and Meta-Analysis
Silvio Porto Junior1, Davi Amorim Meira1, Beatriz Lopes Bernardo da Cunha2
1Department of Medicine, Bahiana School of Medicine, Salvador , Bahia , Brazil.
Insights
This meta-analysis found no significant difference in recurrence or complications between active drainage and passive drainage for chronic subdural hematoma (CSDH) management. Further large-scale trials are needed to confirm these findings for CSDH patients.
Area of Science:
- Neurosurgery
- Medical Technology
- Evidence-Based Medicine
Background:
- Chronic subdural hematoma (CSDH) management utilizes various surgical techniques, with drainage systems being crucial.
- The comparative efficacy of passive drainage (PD) and active drainage (AD) for CSDH remains debated.
- Existing studies present conflicting evidence regarding recurrence rates and outcomes for PD versus AD.
Purpose of the Study:
- To conduct a systematic review and meta-analysis comparing active drainage versus passive drainage in CSDH management.
- To resolve the controversy surrounding the optimal drainage modality for post-evacuation CSDH.
- To provide evidence-based clarity on the efficacy and safety of AD versus PD.
Main Methods:
- Systematic review and meta-analysis adhering to PRISMA guidelines.
- Searched PubMed, Embase, and Web of Science databases up to February 2024.
- Included studies comparing active versus passive drainage for subdural hematomas, with rigorous risk of bias assessment.
Main Results:
- Analysis of 1949 patients (AD) and 1346 patients (PD) showed no significant difference in recurrence rates (13.6% vs. 16.4%).
- Complication rates (7.5% vs. 12.6%), infection (2% vs. 2.6%), hemorrhage (1.1% vs. 2.2%), and mortality (2.7% vs. 2.5%) were also comparable between AD and PD.
- No statistically significant disparities were observed for any outcome between the two drainage modalities.
Conclusions:
- Passive drainage and active drainage demonstrate comparable efficacy in managing CSDH regarding recurrence and complications.
- No significant differences were found in infection, hemorrhage, or mortality rates between PD and AD.
- Further large-scale randomized controlled trials are warranted to definitively establish the optimal drainage strategy for CSDH.
Background And Objectives:
Chronic subdural hematoma (CSDH) management involves various surgical techniques, with drainage systems playing a pivotal role. While passive drainage (PD) and active drainage (AD) are both used, their efficacy remains contentious. Some studies favor PD for lower recurrence rates, while others suggest AD superiority. A systematic review and meta-analysis were conducted to address this controversy, aiming to provide clarity on optimal drainage modalities post-CSDH evacuation.
Methods:
This systematic review and meta-analysis followed preferred reporting items for systematic reviews guidelines, searching PubMed, Embase, and Web of Science until February 2024. Inclusion criteria focused on studies comparing active vs PD for subdural hematomas. Data extraction involved independent researchers, and statistical analysis was conducted using R software. The assessment of risk of bias was performed using the Risk of Bias in Non-Randomized Studies of Interventions framework and the Risk Of Bias 2 tool.
Results:
In this meta-analysis, involving 1949 patients with AD and 1346 with PD, no significant differences were observed in recurrence rates between the active (13.6%) and passive (16.4%) drainage groups (risk ratio [RR] = 0.87; 95% CI: 0.58-1.31). Similarly, for complications, infection, hemorrhage, and mortality, no significant disparities were found between the 2 drainage modalities. Complication rates were 7.5% for active and 12.6% for PD (RR = 0.74; 95% CI: 0.36-1.52). Infection rates were available for 635 patients of the active group, counting for 2% and 2.6%, respectively (RR = 0.98; 95% CI: 0.24-4.01). Hemorrhage rates were also available for 635 patients of the active group, counting for 1.1% and 2.2%, respectively (RR = 0.44; 95% CI: 0.11-1.81). Mortality rates were 2.7% and 2.5%, respectively (RR = 0.94; 95% CI: 0.61-1.46).
Conclusion:
Our study found no significant difference between passive and AD for managing complications, recurrence, infection, hemorrhage, or mortality in CSDH cases. Further large-scale randomized trials are needed for clarity.
