Download PDF
CC BY 4.0 · Journal of Health and Allied Sciences NU 2024; 14(01): 085-093
DOI: 10.1055/s-0043-1764359
Original Article

Factors Associated with Recurrence in Chronic Subdural Hematoma following Surgery

Kritsada Buakate 
1   Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
,
Thara Tunthanathip 
1   Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
› Author Affiliations Funding None.
› Further Information
   Permissions and Reprints

Abstract

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.

Keywords

Chronic Subdural Hematoma - burr hole - recurrence - traumatic brain injury

Ethical Approval

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.


Authors' Contributions

K.B. and T.T. conceived the study and designed the method. K.B. supervised the completion of the data collection. T.T. undertook the recruitment of participating centers and patients and managed the data, including quality control. T.T. provided statistical advice on the study design and analyzed the data, while K.B. drafted the manuscript, and all authors contributed substantially to its revision. T.T. and K.B. take responsibility for the paper as a whole.




Publication History

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/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 12 Ramachandran R, Hegde T. Chronic subdural hematomas--causes of morbidity and mortality. Surg Neurol 2007; 67 (04) 367-372 , discussion 372–373
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefGoogle Scholar
  • 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
    CrossrefGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    CrossrefGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 33 Gernsback J, Kolcun JP, Jagid J. To drain or two drains: recurrences in chronic subdural hematomas. World Neurosurg 2016; 95: 447-450
    CrossrefPubMedGoogle Scholar
  • 34 Nath A, Fotedar S. Management of chronic subdural hematoma: our experience of last seven years. Int Surg J. 2021; 8 (10) 3098-3102
    CrossrefGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar