Subdural versus subgaleal drains: Impact on postoperative complications and length of stay following subdural hematoma evacuation.

BACKGROUND

Subdural hematoma (SDH) is a common neurosurgical pathology, typically managed surgically in symptomatic cases. We aimed compare postoperative outcomes between subdural and subgaleal drain placements in SDH patients at single Scottish neurosurgical centre.

METHODS

Retrospective chart review of all non-acute SDH cases undergoing surgery between October 2022 and August 2024 undertaken. Patients were identified using ICD-10 codes and confirmed via electronic records. Their post-operative course, and the length of stay were compared between the two drain types.

RESULTS

Among the 55 SDH cases, 48 (87.3%) were males and 7 (12.7%) females. The mean age was 75 years (range 22-87, SD=10.93). Nine (16.4%) cases were subacute, 15 (27.3%) acute-on-chronic, and 31 (56.4%) were chronic. Forty one patients (74.5%) underwent unilateral burr hole evacuation, 6 (10.9%) had bilateral hematoma evacuation and 7 (12.7%) had mini-craniotomy. Only 1 (1.8%) patient had a standard craniotomy. Among these, 23 (41.8%) had subgaleal and 32 (58.2%) had subdural drains. Mean drain duration was 2 days (range 1-4, SD 0.52). Post-op complications included hematoma recurrence (20%), infections (7.3%), seizures (14.5%), pneumocephalus (73.5%) and scalp swelling (3.6%). One post-op death occurred. The median hospital stay was 7 days, with mean modified Rankin Scale at discharge of 2.5. No statistically significant differences were observed in recurrence (OR=0.76, p=0.75), infections (OR=0.45, p=0.63), pneumocephalus (OR=1.27, p=0.76), seizures (OR=0.17, p=0.12), or length of hospital stay (Z=-1.47, p=0.14) between the two drain types.

CONCLUSION

Subdural and subgaleal drains yielded no significant differences in the rates of recurrence, postoperative infections, and length of hospital stay in this cohort.