Introduction: Chronic subdural haematoma (CSDH) recurrence remains a challenge with reported rates approaching 20%. This study investigates independent factors predicting recurrence in a large cohort of CSDH patients.
Methods: We retrospectively reviewed 331 consecutive operative CSDH cases between 2005-2009. Univariate, multivariate, and statistical selection modeling was completed identifying factors influencing recurrence requiring repeat drainage within 2-months. A model was developed to identify and quantify patients’ recurrence risk based on age, haematoma volume, and presence of loculations.
Results: The majority of patients were male (80.66%). Mean post-operative haematoma volume was 63.55cc. Factors associated with higher post-operative haematoma volume were loculated (septated) CSDHs, pre-operative volume, midline shift, age, and atrophy. All factors except midline shift were independently predictive of larger post-operative haematoma.
The recurrence rate for repeat drainage was 12%. Loculated CSDHs was the only independent predictor for reoperation. A scoring system was created to quantify recurrence. Higher recurrence rates were found amongst higher patient scores. Scores of 0, 1, 2, and 3 resulted in recurrence rates of 4.76%, 11.72%, 13.83%, and 20.69%, respectively.
Conclusions: Haematoma volume, age, and presence of loculations are found to most strongly influence operative recurrence. A scoring model for identifying higher risk patients for recurrence was developed.
Patient Care: Identifying patients at higher risk of CSDH recurrence may change clinical practice by alerting the neurosurgical team as to who should be followed more closely clinically and/or radiologically.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Recognize independent risk factors of CSDH recurrence
2) Identify and stratify patients' risk of CSDH recurrence based on the presented scoring model