Transition of a Clinical Practice to Use of Subdural Drains after Burr Hole Evacuation of Chronic Subdural Hematoma : The Helsinki Experience

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Pysyväisosoite

http://hdl.handle.net/10138/318309

Lähdeviite

Tommiska , P , Lonnrot , K , Raj , R , Luostarinen , T & Kivisaari , R 2019 , ' Transition of a Clinical Practice to Use of Subdural Drains after Burr Hole Evacuation of Chronic Subdural Hematoma : The Helsinki Experience ' , World Neurosurgery , vol. 129 , pp. E614-E626 . https://doi.org/10.1016/j.wneu.2019.05.230

Julkaisun nimi: Transition of a Clinical Practice to Use of Subdural Drains after Burr Hole Evacuation of Chronic Subdural Hematoma : The Helsinki Experience
Tekijä: Tommiska, Pihla; Lonnrot, Kimmo; Raj, Rahul; Luostarinen, Teemu; Kivisaari, Riku
Tekijän organisaatio: HUS Neurocenter
Neurokirurgian yksikkö
Department of Neurosciences
Clinicum
Helsinki University Hospital Area
HUS Perioperative, Intensive Care and Pain Medicine
Department of Diagnostics and Therapeutics
Anestesiologian yksikkö
Päiväys: 2019-09
Kieli: eng
Sivumäärä: 13
Kuuluu julkaisusarjaan: World Neurosurgery
ISSN: 1878-8750
DOI-tunniste: https://doi.org/10.1016/j.wneu.2019.05.230
URI: http://hdl.handle.net/10138/318309
Tiivistelmä: BACKGROUND: A number of randomized controlled trials have shown the benefit of drain placement in the operative treatment of chronic subdural hematoma (CSDH); however, few reports have described real-life results after adoption of drain placement into clinical practice. We report the results following a change in practice at Helsinki University Hospital from no drain to subdural drain (SD) placement after burr hole craniostomy for CSDH. METHODS: We conducted a retrospective observational study of consecutive patients undergoing burr hole craniostomy for CSDH. We compared outcomes between a 6-month period when SD placement was arbitrary (Julye December 2015) and a period when SD placement for 48 hours was routine (July-December 2017). Our primary outcome of interest was recurrence of CSDH necessitating reoperation within 6 months. Patient outcomes, infections, and other complications were assessed as well. RESULTS: A total of 161 patients were included, comprising 71 (44%) in the drain group and 90 (56%) in the non-drain group. There were no significant differences in age, comorbidities, history of trauma, or use of antithrombotic agents between the 2 groups (P > 0.05 for all). Recurrence within 6 months occurred in 18% of patients in the non-drain group, compared with 6% in the drain group (odds ratio, 0.28; 95% confidence interval, 0.09-0.87; P = 0.028). There were no differences in neurologic outcomes (P = 0.72), mortality (P = 0.55), infection rate (P = 0.96), or other complications (P = 0.20). CONCLUSIONS: The change in practice from no drain to use of an SD after burr hole craniostomy for CSDH effectively reduced the 6-month recurrence rate with no effect on patient outcomes, infections, or other complications.
Avainsanat: Burr hole
Chronic subdural hematoma
Drain
Neurosurgery
Recurrence
Subdural drain
Surgery
CLOSED-SYSTEM DRAINAGE
INTERNATIONAL SURVEY
QUESTIONNAIRE SURVEY
RISK-FACTORS
MANAGEMENT
RECURRENCE
SUBACUTE
IRRIGATION
PREDICTORS
PLACEMENT
3112 Neurosciences
3124 Neurology and psychiatry
3126 Surgery, anesthesiology, intensive care, radiology
Vertaisarvioitu: Kyllä
Tekijänoikeustiedot: cc_by_nc_nd
Pääsyrajoitteet: openAccess
Rinnakkaistallennettu versio: acceptedVersion


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