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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.
Operative Neurosurgery (Hagerstown, Md.)
|July 5, 2024
Summary
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.
