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Effect of the postoperative Trendelenburg position on chronic subdural hematoma recurrence: a pilot clinical trial
Jorge H Montenegro1,2,3, Santiago Ángel1, Pablo A Botero4
11Department of Neurosurgery, Universidad de Antioquia, Medellín.
Insights
The postoperative Trendelenburg position significantly reduced chronic subdural hematoma (CSH) recurrence and improved patient outcomes after surgical drainage. This finding suggests a potential new standard of care for CSH patients.
Area of Science:
- Neurosurgery
- Clinical Trials
- Patient Outcomes
Background:
- Chronic subdural hematoma (CSH) is a common neurosurgical condition.
- Surgical drainage is the primary treatment for symptomatic CSH.
- Recurrence rates after surgical drainage can be significant, impacting patient recovery.
Purpose of the Study:
- To evaluate the impact of the postoperative Trendelenburg position on CSH recurrence.
- To assess functional outcomes and patient comfort following surgical drainage for CSH.
- To investigate the efficacy of the Trendelenburg position in preventing CSH re-accumulation.
Main Methods:
- A pilot randomized controlled trial involving 46 patients with CSH across three Colombian hospitals.
- Patients were assigned to either a 24-hour postoperative Trendelenburg position (intervention) or a flat position (control).
- Outcomes measured included CSH recurrence at 3 months, modified Rankin Scale (mRS) scores, adverse events, and patient comfort.
Main Results:
- CSH recurrence was significantly lower in the Trendelenburg group (4.8%) compared to the control group (28.6%; p = 0.038).
- Favorable functional outcomes (mRS 0-2) were achieved in 95.2% of the intervention group versus 66.7% in the control group (p = 0.025).
- Patient comfort levels were comparable between the two groups (p = 0.979).
Conclusions:
- The postoperative Trendelenburg position demonstrates a significant association with reduced CSH recurrence.
- Improved functional outcomes at 3 months were observed in patients treated with the Trendelenburg position post-surgery.
- Further clinical studies are warranted to solidify these findings and guide clinical practice for CSH management.
Objective:
The aim of the study was to evaluate the effect of the postoperative Trendelenburg position on the recurrence of chronic subdural hematoma (CSH) in patients after surgical drainage.
Methods:
A pilot randomized, controlled clinical trial was conducted in 3 hospitals in Colombia. Patients with CSH were enrolled and assigned to a Trendelenburg position (30° leg elevation and 10° head tilt; intervention group) or to a flat position (control group) for 24 hours postoperatively. CSH recurrence was measured at 3 months, along with functional outcome (modified Rankin Scale [mRS] score), adverse events, and patient comfort.
Results:
Twenty-three patients were assigned to the Trendelenburg group and 23 to the control group. Two patients from the intervention group were assigned to the control group because of minor complications. Recurrence of CSH was 4.8% in the intervention group and 28.6% in the control group (p = 0.038). A favorable outcome (mRS score 0-2) was achieved in 95.2% of the intervention group versus 66.7% in the control group (p = 0.025). Patient comfort was equal in both groups (47.6% vs 48%, p = 0.979).
Conclusions:
In patients with CSH who require surgery, the postoperative Trendelenburg position is associated with lower recurrence and improved functional outcome at 3 months. Further studies are required to obtain more clinical evidence.
