Reduced risk of reoperation of chronic subdural hematoma in patients treated with active subgaleal drainage compared with passive subdural drainage
(2025) In Journal of Neurosurgery 143(5). p.1227-1233- Abstract
OBJECTIVE Chronic subdural hematoma (CSDH) is a common cause of morbidity in the older population and the incidence of CSDH is likely to increase in upcoming years due to the increasing age of the population. Surgical intervention is the cornerstone of treatment, but trials have shown conflicting results regarding the optimal type of surgical drainage. The aim of this study was to compare outcomes between patients with CSDH who were surgically treated with active subgaleal drainage versus passive subdural drainage. METHODS This retrospective single-center cohort study included patients who underwent surgery for CSDH from 2020 to 2022. In a neurosurgical department in Lund, Sweden, the clinical routine changed from use of a passive... (More)
OBJECTIVE Chronic subdural hematoma (CSDH) is a common cause of morbidity in the older population and the incidence of CSDH is likely to increase in upcoming years due to the increasing age of the population. Surgical intervention is the cornerstone of treatment, but trials have shown conflicting results regarding the optimal type of surgical drainage. The aim of this study was to compare outcomes between patients with CSDH who were surgically treated with active subgaleal drainage versus passive subdural drainage. METHODS This retrospective single-center cohort study included patients who underwent surgery for CSDH from 2020 to 2022. In a neurosurgical department in Lund, Sweden, the clinical routine changed from use of a passive subdural drain to an active subgaleal drain during this period. Data were collected from patient medical records and analyzed using univariable analysis followed by multivariable logistic regression analysis. The primary outcome was reoperation for recurrent hematoma within 3 months. Secondary outcomes were postoperative morbidity and mortality. RESULTS Of 452 patients (331 male, median age 78 years) included in the analysis, 3 were lost to follow-up, leaving 230 patients who received passive subdural drainage and 219 patients who received active subgaleal drainage for outcomes assessment. The risk of recurrent surgery for CSDH within 3 months was significantly lower in the active subgaleal drain group (12.7%) compared with the passive subdural drain group (20.1%) (p = 0.022). Regarding secondary outcomes, no statistically significant differences were found. CONCLUSIONS Risk of recurrent CSDH requiring surgery was lower in patients who received active subgaleal drainage compared with those who received passive subdural drainage, with no increased risk of postoperative complications. These findings support use of the active subgaleal drain system for CSDH surgery.
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- author
- Grubor, Irena LU ; Baldvinsdóttir, Bryndís LU ; Al-Hesnawi, Murtadha and Redebrandt, Henrietta Nittby
- organization
- publishing date
- 2025-11
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- chronic subdural hematoma, drain, outcome, recurrence, surgeon experience, surgeon sex, trauma
- in
- Journal of Neurosurgery
- volume
- 143
- issue
- 5
- pages
- 7 pages
- publisher
- American Association of Neurological Surgeons
- external identifiers
-
- pmid:40815860
- scopus:105020683581
- ISSN
- 0022-3085
- DOI
- 10.3171/2025.4.JNS242409
- language
- English
- LU publication?
- yes
- additional info
- Publisher Copyright: ©AANS 2025, except where prohibited by US copyright law.
- id
- efd6bba2-e86e-48a7-a7c1-0e29aebd9fac
- date added to LUP
- 2025-12-15 14:13:38
- date last changed
- 2025-12-15 14:14:02
@article{efd6bba2-e86e-48a7-a7c1-0e29aebd9fac,
abstract = {{<p>OBJECTIVE Chronic subdural hematoma (CSDH) is a common cause of morbidity in the older population and the incidence of CSDH is likely to increase in upcoming years due to the increasing age of the population. Surgical intervention is the cornerstone of treatment, but trials have shown conflicting results regarding the optimal type of surgical drainage. The aim of this study was to compare outcomes between patients with CSDH who were surgically treated with active subgaleal drainage versus passive subdural drainage. METHODS This retrospective single-center cohort study included patients who underwent surgery for CSDH from 2020 to 2022. In a neurosurgical department in Lund, Sweden, the clinical routine changed from use of a passive subdural drain to an active subgaleal drain during this period. Data were collected from patient medical records and analyzed using univariable analysis followed by multivariable logistic regression analysis. The primary outcome was reoperation for recurrent hematoma within 3 months. Secondary outcomes were postoperative morbidity and mortality. RESULTS Of 452 patients (331 male, median age 78 years) included in the analysis, 3 were lost to follow-up, leaving 230 patients who received passive subdural drainage and 219 patients who received active subgaleal drainage for outcomes assessment. The risk of recurrent surgery for CSDH within 3 months was significantly lower in the active subgaleal drain group (12.7%) compared with the passive subdural drain group (20.1%) (p = 0.022). Regarding secondary outcomes, no statistically significant differences were found. CONCLUSIONS Risk of recurrent CSDH requiring surgery was lower in patients who received active subgaleal drainage compared with those who received passive subdural drainage, with no increased risk of postoperative complications. These findings support use of the active subgaleal drain system for CSDH surgery.</p>}},
author = {{Grubor, Irena and Baldvinsdóttir, Bryndís and Al-Hesnawi, Murtadha and Redebrandt, Henrietta Nittby}},
issn = {{0022-3085}},
keywords = {{chronic subdural hematoma; drain; outcome; recurrence; surgeon experience; surgeon sex; trauma}},
language = {{eng}},
number = {{5}},
pages = {{1227--1233}},
publisher = {{American Association of Neurological Surgeons}},
series = {{Journal of Neurosurgery}},
title = {{Reduced risk of reoperation of chronic subdural hematoma in patients treated with active subgaleal drainage compared with passive subdural drainage}},
url = {{http://dx.doi.org/10.3171/2025.4.JNS242409}},
doi = {{10.3171/2025.4.JNS242409}},
volume = {{143}},
year = {{2025}},
}