Subdural irrigation in burr-hole drainage procedure reduces reoperation rate in patients with chronic subdural hematoma

1. Patients who underwent burr-hole drainage with subdural irrigation had fewer reoperation rates with comparable functional outcomes than those without subdural irrigation.

2. Functional outcomes were similar between groups.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Chronic subdural hematoma is an emergency that is often treated with burr-hole drainage surgery. While using a subdural drain is known to be beneficial, the impact of subdural irrigation has not been fully explored. This randomized controlled trial aimed to determine whether subdural irrigation is necessary for burr-hole drainage surgery. The primary outcome of this study was the 6-month reoperation rate, while a key secondary outcome was the proportion of patients with unfavourable functional outcomes, measured by the modified Rankin Scale (mRS). According to study results, patients with subdural irrigation had a lower reoperation rate than those who did not receive subdural irrigation. Although this study was well done, it was limited by the neurosurgeons and operating room staff not being masked to the treatment allocation, which could introduce bias.

Click to read the study in The Lancet

Relevant Reading: Dexamethasone versus Surgery for Chronic Subdural Hematoma

In-depth [randomized controlled trial]: Between Jan 1, 2020, and Aug 17, 2022, 1644 patients were screened for eligibility across 5 neurosurgical units in Finland. Included were patients ≥ 18 years old with chronic subdural hematoma requiring burr-hole drainage. Altogether, 490 patients (246 in burr-hole drainage with irrigation and 244 in drainage without irrigation) were included in the final analysis. The primary outcome of reoperation rate was lower in the irrigation group compared to the non-irrigation group (12.6% vs. 18.3%, respectively, 95% confidence interval [CI] 0.2-11.7, p=0.30). Regarding functional outcomes, the proportion of people with mRS 4-6 was comparable (12.6% in irrigation vs. 13.1% in no-irrigation, p=0.89) as was the mortality rate between groups (7.1% vs. 6.1%, p=0.58). Findings from this study suggest that subdural irrigation during burr-hole drainage surgery reduces reoperation rate without affecting functional outcomes or mortality.

Image: PD

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