title: Treatment of chronic subdural hematomas with subdural evacuating port system placement in the intensive care unit: evolution of practice and comparison with bur hole evacuation in the operating room.
abstract: OBJECTIVE The aims of this study were to evaluate a multiyear experience with subdural evacuating port system (SEPS) placement for chronic subdural hematoma (cSDH) in the intensive care unit at a tertiary neurosurgical center and to compare SEPS placement with bur hole evacuation in the operating room. METHODS All cases of cSDH evacuation were captured over a 7-year period at a tertiary neurosurgical center within an integrated health care delivery system. The authors compared the performance characteristics of SEPS and bur hole placement with respect to recurrence rates, change in recurrence rates over time, complications, length of stay, discharge disposition, and mortality rates. RESULTS A total of 371 SEPS cases and 659 bur hole cases were performed (n = 1030). The use of bedside SEPS placement for cSDH treatment increased over the 7-year period, from 14% to 80% of cases. Reoperation within 6 months was higher for the SEPS (15.6%) than for bur hole drainage (9.1%) across the full 7-year period (p = 0.002). This observed overall difference was due to a higher rate of reoperation during the same hospitalization (7.0% for SEPS vs 3.2% for bur hole; p = 0.008). Over time, as the SEPS procedure became more common and modifications of the SEPS technique were introduced, the rate of in-hospital reoperation after SEPS decreased to 3.3% (p = 0.02 for trend), and the difference between SEPS and bur hole recurrence was no longer significant (p = 0.70). Complications were uncommon and were similar between the groups. CONCLUSIONS Overall performance characteristics of bedside SEPS and bur hole drainage in the operating room were similar. Modifications to the SEPS technique over time were associated with a reduced reoperation rate.
authors.affiliation: Department of Neurosurgery, Kaiser Permanente, Redwood City.|Division of Research, Kaiser Permanente Northern California, Oakland; and.
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Flint
authors.affiliation: Department of Neurosurgery, Kaiser Permanente, Redwood City.
authors.forename: Sheila L
authors.initials: SL
authors.lastname: Chan
authors.affiliation: Department of Neurosurgery, Kaiser Permanente, Redwood City.
authors.forename: Vivek A
authors.initials: VA
authors.lastname: Rao
authors.affiliation: Department of Neurosurgery, Kaiser Permanente, Redwood City.
authors.forename: Allen D
authors.initials: AD
authors.lastname: Efron
authors.affiliation: Department of Neurosurgery, Stanford University Medical Center, Stanford, California.
authors.forename: Maziyar A
authors.initials: MA
authors.lastname: Kalani
authors.affiliation: Department of Neurosurgery, Kaiser Permanente, Redwood City.
authors.forename: William F
authors.initials: WF
authors.lastname: Sheridan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage / Q000379:methods*; D005260:Female; D020200:Hematoma, Subdural, Chronic / Q000601:surgery*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D009873:Operating Rooms; D012086:Reoperation; D013355:Subdural Space / Q000601:surgery; D016896:Treatment Outcome; D014207:Trephining
keywords: EMR = electronic medical record; ICU = intensive care unit; IDEAL = Idea, Development, Exploration, Assessment and Long-term follow-up; LOS = length of stay; OR = operating room; SEPS; SEPS = subdural evacuating port system; bur hole drainage; cSDH = chronic subdural hematoma; intensive care unit; operating room; subdural evacuating port system; subdural hematoma; surgical technique