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Factors Associated with Recurrence in Chronic Subdural Hematoma following SurgeryFunding None.
Background Recurrence is a frequent complication after surgery in a chronic subdural hematoma (CSDH). This study aimed to describe the recurrent rate of CSDH after surgery. In addition, a secondary objective aimed to explore factors associated with the recurrence of CSDH after surgery.
Methods A total of 141 surgical CSDH patients were analyzed in this retrospective study. The Cox regression method was used to conduct both univariate and multivariate analyses of variables associated with recurrence. As a result, the cumulative incidence of recurrence for each covariate survival curve was built after the final model.
Results Twenty-two percent of the patients showed evidence of recurrence. Initially, four variables (Glasgow coma scale score 3–8, clopidogrel, operative time, and amount of irrigated saline) had potential factors in univariate analysis but only clopidogrel and amount of saline irrigation were significantly associated with CSDH recurrence.
Conclusion Preoperative clopidogrel and the amount of saline irrigation were found to be associated with the recurrence rate. Factors associated with CSDH recurrence should be developed and validated as the clinical prediction tool for implication in general practice.
A human research ethics committee of Faculty of Medicine, Prince of Songkla University approved this study (REC 64–395–10–1) on September, 14 2021.
KB and TT conceived the study and designed the method. KB supervised the completion of the data collection. TT undertook the recruitment of participating centers and patients and managed the data, including quality control. TT provided statistical advice on the study design and analyzed the data, while KB drafted the manuscript, and all authors contributed substantially to its revision. TT and KB take responsibility for the paper as a whole.
Article published online:
18 April 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
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- 1 Rauhala M, Luoto TM, Huhtala H. et al. The incidence of chronic subdural hematomas from 1990 to 2015 in a defined Finnish population. J Neurosurg 2019; 132 (04) 1147-1157
- 2 Miah IP, Holl DC, Peul WC. et al; Dutch Subdural Hematoma Research Group (DSHR). Dexamethasone therapy versus surgery for chronic subdural haematoma (DECSA trial): study protocol for a randomised controlled trial. Trials 2018; 19 (01) 575 DOI: 10.1186/s13063-018-2945-4.
- 3 Ryu SM, Yeon JY, Kong DS, Hong SC. Risk of recurrent chronic subdural hematoma associated with early warfarin resumption: a matched cohort study. World Neurosurg 2018; 120: e855-e862
- 4 Weigel R, Schmiedek P, Krauss JK. Outcome of contemporary surgery for chronic subdural haematoma: evidence based review. J Neurol Neurosurg Psychiatry 2003; 74 (07) 937-943
- 5 Ohba S, Kinoshita Y, Nakagawa T, Murakami H. The risk factors for recurrence of chronic subdural hematoma. Neurosurg Rev 2013; 36 (01) 145-149 , discussion 149–150
- 6 Oh HJ, Lee KS, Shim JJ, Yoon SM, Yun IG, Bae HG. Postoperative course and recurrence of chronic subdural hematoma. J Korean Neurosurg Soc 2010; 48 (06) 518-523
- 7 Schwarz F, Loos F, Dünisch P. et al. Risk factors for reoperation after initial burr hole trephination in chronic subdural hematomas. Clin Neurol Neurosurg 2015; 138: 66-71
- 8 Cofano F, Pesce A, Vercelli G. et al. Risk of recurrence of chronic subdural hematomas after surgery: a multicenter observational cohort study. Front Neurol 2020; 11: 560269 DOI: 10.3389/fneur.2020.560269.
- 9 Han MH, Ryu JI, Kim CH, Kim JM, Cheong JH, Yi HJ. Predictive factors for recurrence and clinical outcomes in patients with chronic subdural hematoma. J Neurosurg 2017; 127 (05) 1117-1125
- 10 Chon KH, Lee JM, Koh EJ, Choi HY. Independent predictors for recurrence of chronic subdural hematoma. Acta Neurochir (Wien) 2012; 154 (09) 1541-1548
- 11 Miah IP, Tank Y, Rosendaal FR. et al; Dutch Chronic Subdural Hematoma Research Group. Radiological prognostic factors of chronic subdural hematoma recurrence: a systematic review and meta-analysis. Neuroradiology 2021; 63 (01) 27-40
- 12 Ramachandran R, Hegde T. Chronic subdural hematomas--causes of morbidity and mortality. Surg Neurol 2007; 67 (04) 367-372 , discussion 372–373
- 13 Mori K, Maeda M. Surgical treatment of chronic subdural hematoma in 500 consecutive cases: clinical characteristics, surgical outcome, complications, and recurrence rate. Neurol Med Chir (Tokyo) 2001; 41 (08) 371-381
- 14 Tunthanathip T, Sangkhathat S. Temozolomide for patients with wild-type isocitrate dehydrogenase (IDH) 1 glioblastoma using propensity score matching. Clin Neurol Neurosurg 2020; 191: 105712 DOI: 10.1016/j.clineuro.2020.105712.
- 15 Tunthanathip T, Sangkhathat S, Tanvejsilp P, Kanjanapradit K. Prognostic impact of the combination of MGMT methylation and TERT promoter mutation in glioblastoma. J Neurosci Rural Pract 2021; 12 (04) 694-703
- 16 Taweesomboonyat T, Kaewborisutsakul A, Tunthanathip T, Saeheng S, Oearsakul T. Necessity of in-hospital neurological observation for mild traumatic brain injury patients with negative computed tomography brain scans. J Health Sci Med Res 2020; 38: 267-274
- 17 Nakaguchi H, Tanishima T, Yoshimasu N. Factors in the natural history of chronic subdural hematomas that influence their postoperative recurrence. J Neurosurg 2001; 95 (02) 256-262
- 18 Datamethods.com. Hazard ratio plots with non-linear & time-varying effects in R [internet]. 2018 [cited 2022 Jul 5]. Accessed February 8, 2023 at: https://discourse.datamethods.org/t/hazard-ratio-plots-with-non-linear-time-varying-effects-in-r/1123
- 19 Stackexchange.com. Plot of hazard ratio for primary endpoint and continuous covariate [internet]. 2021 [cited 2022 May5]. Accessed February 8, 2023 at: https://stats.stackexchange.com/questions/551410/plot-of-hazard-ratio-for-primary-endpoint-and-continuous-covariate
- 20 Singh A, Kour A, Chaudhari DM. Chronic subdural hematoma: surgical management and outcome in newly established neurosurgical unit: experience of 78 patients operated over 1 year. Apollo Med 2018; 15: 193-196
- 21 Gunjkar J, Vhora SS, Pingalkar V. Chronic subdural hematomas: an institutional review of 24 operated patients. Chronic subdural hematomas: an institutional review of 24 operated patients. Int J Contemp Med Surg Radiol 2019; 4 (03) C48 –C51
- 22 Santarius T, Kirkpatrick PJ, Ganesan D. et al. Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial. Lancet 2009; 374 (9695): 1067-1073
- 23 Leroy HA, Aboukaïs R, Reyns N. et al. Predictors of functional outcomes and recurrence of chronic subdural hematomas. J Clin Neurosci 2015; 22 (12) 1895-1900
- 24 Kerttula S, Huttunen J, Leinonen V, Kämäräinen OP, Danner N. The effect of antithrombotic therapy on the recurrence and outcome of chronic subdural hematoma after burr-hole craniostomy in a population-based cohort. Acta Neurochir (Wien) 2022; 164 (10) 2699-2708
- 25 Poon MTC, Rea C, Kolias AG, Brennan PM. British Neurosurgical Trainee Research Collaborative (BNTRC). Influence of antiplatelet and anticoagulant drug use on outcomes after chronic subdural hematoma drainage. J Neurotrauma 2021; 38 (08) 1177-1184
- 26 Nagelschmitz J, Blunck M, Kraetzschmar J, Ludwig M, Wensing G, Hohlfeld T. Pharmacokinetics and pharmacodynamics of acetylsalicylic acid after intravenous and oral administration to healthy volunteers. Clin Pharmacol 2014; 6: 51-59
- 27 Savi P, Herbert JM. Clopidogrel and ticlopidine: P2Y12 adenosine diphosphate-receptor antagonists for the prevention of atherothrombosis. Semin Thromb Hemost 2005; 31 (02) 174-183
- 28 Choi J, Whang K, Cho S, Kim J. Comparison of outcomes and recurrence in chronic subdural hematoma patients treated by burr-hole drainage with or without irrigation. Trauma Inj 2020; 33 (02) 81-88
- 29 Ishibashi A, Yokokura Y, Adachi H. A comparative study of treatments for chronic subdural hematoma: burr hole drainage versus burr hole drainage with irrigation. Kurume Med J 2011; 58 (01) 35-39
- 30 Jang KM, Kwon JT, Hwang SN, Park YS, Nam TK. Comparison of the outcomes and recurrence with three surgical techniques for chronic subdural hematoma: single, double burr hole, and double burr hole drainage with irrigation. Korean J Neurotrauma 2015; 11 (02) 75-80
- 31 Bhatnagar SR. Plot Hazards and Hazard Ratios. [internet]. 2022 [cited 2023 Jan 5]. Accessed February 8, 2023 at: https://cran.r-project.org/web/packages/casebase/vignettes/plotsmoothHazard.html
- 32 Chang C, Hsieh MK, Chang WY, Chiang AJ, Chen J. Determining the optimal number and location of cutoff points with application to data of cervical cancer. PLoS One 2017; 12 (04) e0176231 DOI: 10.1371/journal.pone.0176231.
- 33 Gernsback J, Kolcun JP, Jagid J. To drain or two drains: recurrences in chronic subdural hematomas. World Neurosurg 2016; 95: 447-450
- 34 Nath A, Fotedar S. Management of chronic subdural hematoma: our experience of last seven years. Int Surg J. 2021; 8 (10) 3098-3102
- 35 Tunthanathip T, Duangsuwan J, Wattanakitrungroj N, Tongman S, Phuenpathom N. Clinical nomogram predicting intracranial injury in pediatric traumatic brain injury. J Pediatr Neurosci 2020; 15 (04) 409-415
- 36 Tunthanathip T, Duangsuwan J, Wattanakitrungroj N, Tongman S, Phuenpathom N. Comparison of intracranial injury predictability between machine learning algorithms and the nomogram in pediatric traumatic brain injury. Neurosurg Focus 2021; 51 (05) E7