Discussion
hematoma, hematomas
HEMATOMA, RECURRENCE, HEMATOMAS
This study examined subdural drain dynamics after burr hole evacuation of CSDH. We report that a shorter duration of production (active drain) was significantly correlated with an increased risk of recurrence at three months postoperative follow-up.Cases with an active drain until 17–24 hours after surgery had a significantly lower risk of symptomatic recurrence (compared to active drain < 8 hours after surgery) when adjusted for age, gender, size of hematoma, bilateral occurrence, midline shift, and anticoagulant use. We also observed that total volume produced is statistically significant for the risk of recurrence, as lower production increases the risk within the first 3 months post-operatively.We know from previously randomized controlled trials that subdural drainage is important for reducing the risk of CSDH recurrence [Due to the composition of membranous and mixed hematomas, their viscosity, and the “intercavity” connections, we assume that these hematomas are more difficult to drain and that the drain is more prone to clogging. However, in our study, the different hematoma types were equally distributed in all three groups, with no significant differences. Perhaps the answer is more complex in that malfunction of the drain also depends on e.g. the hematoma composition at protein level [While previous trials [We report equal production ratios between "mobilization" and "bed rest" in all three groups. So, it seems to be subordinated to whether the patients are lying in bed or is mobilized, in relation to whether the drain is active or not.The observations from this study indicate, that an individual drainage discontinuation strategy up to a maximum of 24 hours after surgery, could be a reasonable alternative to a specific discontinuation time for all patients. However, this question can only be answered through a randomized trial where a fixed drainage time is compared to an individual, production-dependent drainage time. One can argue for individual drainage times from both the health economic perspective and the patient perspective as some patients would be able to be discharged or transferred to another department/hospital earlier. The drain probably deters several patients from adequate mobilization (even though it is allowed), and here individual drainage time is likely to lead to earlier sufficient mobilization. From the nurse’s perspective, however, it is time-consuming to monitor drain production every hour. Therefore, the best overall solution in terms of the risk of CSDH recurrence is probably to ascertain the shortest possible—but equal—drainage time for all patients [