title: Use of subdural drain for chronic subdural haematoma? A 4-year multi-centre observational study of 302 cases.
abstract: Chronic subdural haematoma (CSDH) is a common neurosurgical condition and is more prevalent in the ageing population. Studies have suggested that placement of subdural drains after burr-hole drainage was associated with lower recurrence rates. However, a considerable proportion of surgeons remained unconvinced of the effectiveness of drain placement and concerns exist with the potential complications this additional manoeuvre entails such as infection or bleeding. The aim of the present study is to evaluate the impact of subdural drain on CSDH recurrence and its safety. This is a multicentre observational study. Data of consecutive patients with burr-hole drainage performed for CSDH in three hospitals in Hong Kong during a four-year period from January 2008 to December 2011 were prospectively collected and retrospectively analysed. The primary outcome was symptomatic recurrence requiring re-operation. Secondary outcomes included the modified Rankin scales (mRS), morbidity and mortality at six months. A total of 302 patients were identified. The recurrence rate was 8.72% (13/149) with drain placement versus 16.3% (25/153) with no drain (Odds Ratio=0.489, 95%CI 0.240-0.998; p=0.0463). Local wound infection, subdural empyema, acute subdural haematoma and other complications had no significant difference. Six-month mRS, 30-day mortality and six-month mortality were comparable in both groups. In conclusion, the use of subdural drain significantly reduced recurrence with no significant increase in complications.
authors.affiliation: Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong. Electronic address: davidchan@surgery.cuhk.edu.hk.
authors.forename: David Yuen Chung
authors.initials: DY
authors.lastname: Chan
authors.affiliation: Department of Neurosurgery, Kwong Wah Hospital, Hong Kong. Electronic address: peterymwoo@gmail.com.
authors.forename: Peter Yat Ming
authors.initials: PY
authors.lastname: Woo
authors.affiliation: Department of Neurosurgery, Queen Elizabeth Hospital, Hong Kong. Electronic address: calvinmakhk@yahoo.com.
authors.forename: Calvin Hoi Kwan
authors.initials: CH
authors.lastname: Mak
authors.affiliation: Department of Neurosurgery, Kwong Wah Hospital, Hong Kong. Electronic address: albertochu@hotmail.com.
authors.forename: Alberto Chi Ho
authors.initials: AC
authors.lastname: Chu
authors.affiliation: Department of Orthopaedics and Traumatology, North District Hospital, Hong Kong. Electronic address: hanglsc@gmail.com.
authors.forename: Charles Churk Hang
authors.initials: CC
authors.lastname: Li
authors.affiliation: Department of Neurosurgery, Kwong Wah Hospital, Hong Kong. Electronic address: natalieko_@hotmail.com.
authors.forename: Natalie Man Wai
authors.initials: NM
authors.lastname: Ko
authors.affiliation: Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong. Electronic address: stephanieng@surgery.cuhk.edu.hk.
authors.forename: Stephanie Chi Ping
authors.initials: SC
authors.lastname: Ng
authors.affiliation: Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong. Electronic address: davidsun@surgery.cuhk.edu.hk.
authors.forename: Tin Fung David
authors.initials: TF
authors.lastname: Sun
authors.affiliation: Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong. Electronic address: wpoon@surgery.cuhk.edu.hk.
authors.forename: Wai Sang
authors.initials: WS
authors.lastname: Poon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage / Q000009:adverse effects*; D005260:Female; D020200:Hematoma, Subdural, Chronic / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D014207:Trephining / Q000009:adverse effects*
keywords: Burr hole; Chronic subdural haematoma; Elderly trauma; Head injury; Recurrence; Subdural drain