慢性硬膜下血肿(cSDH)多见于老年患者,而年龄较大的患者与cSDH钻孔引流(BHD)术后预后较差有关。cSDH-Drain试验显示,BHD和放置骨膜下引流(SPD)或硬膜下引流(SDD)后的复发率相当。此外,SPD显示,由于引流管错位,感染率和医源性实质损伤的发生率显着降低。该事后分析旨在比较cSDH的BHD和老年患者中SPD或SDD的放置后的复发率和临床结果。
该研究包括104名80岁及以上的患者(47.3%),来自之前cSDH-Drain试验招募的220名患者。比较了SPD和SDD的复发率,发病率,死亡率,和临床结果。使用逻辑回归的事后分析,在单变量分析中比较<80岁和≥80岁患者的结局测量值,并根据引流类型进行分层,进一步完成。
接受SDD治疗的≥80岁患者的复发率(12.8%)高于接受SPD治疗的患者(8.2%)。无显著性差异(p=0.46)。与SPD相比,80岁以上且接受SDD治疗的患者的引流管错位率明显更高(0%vs20%,p=0.01)。将80岁以上的患者与年轻患者进行比较,总死亡率明显更高(15.4%vs5.2%,p=0.012),30天死亡率(3.8%vs0%,p=0.033),手术死亡率(2.9%vs1.7%,p=0.034)的比率被观察到。≥80岁的患者在12个月随访时的临床结果明显更差。和逻辑回归显示年龄与结局有显著关联,而引流类型与结局无关。
cSDH-Drain试验的初步发现和此子分析的结果表明,老年患者可能需要使用SPD。与排水型相反,患者年龄(>80岁)与不良预后显着相关,以及更高的发病率和死亡率。
Chronic subdural hematoma (cSDH) occurs more frequently in elderly patients, while older patient age is associated with worse postoperative outcome following burr-hole drainage (BHD) of cSDH. The cSDH-Drain trial showed comparable recurrence rates after BHD and placement of either a subperiosteal drain (SPD) or subdural drain (SDD). Additionally, an SPD showed a significantly lower rate of infections as well as iatrogenic parenchymal injuries through drain misplacement. This post hoc analysis aims to compare recurrence rates and clinical outcomes following BHD of cSDH and the placement of SPDs or SDDs in elderly patients.
The study included 104 patients (47.3%) 80 years of age and older from the 220 patients recruited in the preceding cSDH-Drain trial. SPDs and SDDs were compared with regard to recurrence rate, morbidity, mortality, and clinical outcome. A post hoc analysis using logistic regression, comparing the outcome measurements for patients < 80 and ≥ 80 years old in a univariate analysis and stratified for drain type, was further completed.
Patients ≥ 80 years of age treated with an SDD showed higher recurrence rates (12.8%) compared with those treated with an SPD (8.2%), without a significant difference (p = 0.46). Significantly higher drain misplacement rates were observed for patients older than 80 years and treated with an SDD compared with an SPD (0% vs 20%, p = 0.01). Comparing patients older than 80 years to younger patients, significantly higher overall mortality (15.4% vs 5.2%, p = 0.012), 30-day mortality (3.8% vs 0%, p = 0.033), and surgical mortality (2.9% vs 1.7%, p = 0.034) rates were observed. Clinical outcome at the 12-month follow-up was significantly worse for patients ≥ 80 years old, and logistic regression showed a significant association of age with outcome, while drain type had no association with outcome.
The initial findings of the cSDH-Drain trial and the findings of this subanalysis suggest that SPD may be warranted in elderly patients. As opposed to drain type, patient age (> 80 years) was significantly associated with worse outcome, as well as higher morbidity and mortality rates.