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Pre-existing statin use and recurrence in relation to hematoma architecture of chronic subdural hematomas - A

Hussam Hamou1, Hani Ridwan2, Anna Mausberg1

  • 1Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany.

Brain & Spine
|April 21, 2026
PubMed

Insights

Pre-existing statin use does not independently predict recurrence of chronic subdural hematoma (cSDH) after surgery. Hematoma architecture is a stronger predictor of recurrence risk in cSDH patients.

Area of Science:

  • Neurosurgery
  • Cardiology
  • Clinical Pharmacology

Background:

  • Chronic subdural hematoma (cSDH) presents a growing clinical challenge with significant postoperative recurrence rates.
  • While statins like atorvastatin are effective for conservative treatment, their impact on surgical outcomes for cSDH remains under investigation.

Purpose of the Study:

  • To investigate the association between pre-existing statin therapy and the risk of recurrence in patients undergoing surgical treatment for cSDH.
  • To evaluate the influence of hematoma architecture on computed tomography (CT) as a predictor of recurrence.
  • To determine if statin use modifies the effect of hematoma architecture on recurrence risk.

Main Methods:

  • Retrospective cohort study of 564 surgically treated cSDH patients (2015-2023).
  • Data collected on pre-existing statin use, demographics, comorbidities, and medications.
  • Hematoma architecture classified (homogeneous, organized, sedimented, subacute); recurrence defined as reoperation.
  • Multivariable logistic regression and propensity score matching (1:1) employed for analysis.

Main Results:

  • Statin use was documented in 26.6% of patients; recurrence occurred in 30.1%.
  • Initial unadjusted analysis suggested a protective effect of statins, but this became non-significant after adjusting for confounders (OR 0.664, p=0.109).
  • Hematoma architecture was a dominant predictor, with organized hematomas showing a 70% lower recurrence risk (OR 0.303, p < 0.001); no interaction with statin use was found.

Conclusions:

  • Pre-existing statin therapy is not an independent predictor of postoperative cSDH recurrence when accounting for confounders and hematoma characteristics.
  • Hematoma architecture is a significant factor influencing recurrence risk.
  • Further prospective studies on post-surgical statin initiation are warranted.
Abstract

Keywords:
Chronic subdural hematomaHematoma architecturePropensity score matchingRecurrenceStatins

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