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Meta-Analysis
. 2023 Sep 1;25(3):216-241.
doi: 10.1227/ons.0000000000000794. Epub 2023 Jun 30.

Recurrent Chronic Subdural Hematoma After Burr-Hole Surgery and Postoperative Drainage: A Systematic Review and Meta-Analysis

Roger Lodewijkx  1   2 , Merijn Foppen  1   2 , Kari-Anne Mariam Slot  1   2 , William Peter Vandertop  1   2 , Dagmar Verbaan  1   2
Affiliations
Meta-Analysis

Recurrent Chronic Subdural Hematoma After Burr-Hole Surgery and Postoperative Drainage: A Systematic Review and Meta-Analysis

Roger Lodewijkx et al. Oper Neurosurg. .

Abstract

Background and objective: Reported recurrence rates of chronic subdural hematoma treated by burr-hole surgery with postoperative drainage vary considerably in the literature. We performed a systematic review and meta-analysis to define the recurrence rate of burr-hole surgery with postoperative drainage.

Methods: PubMed and EMBASE were searched, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. We used the Newcastle-Ottawa scale and Cochrane risk-of-bias tool for quality assessment of included studies and the random-effects model to calculate pooled incidence rates in R with the metaprop function if appropriate.

Results: The search yielded 2969 references; 709 were screened full text, and 189 met the inclusion criteria. In 174 studies (34 393 patients), the number of recurrences was reported as per patient and 15 studies (3078 hematomas) reported the number of recurrences per hematoma, for a pooled incidence of 11.2% (95% CI: 10.3-12.1; I 2 = 87.7%) and 11.0% (95% CI: 8.6-13.4; I 2 = 78.0%), respectively. The pooled incidence of 48 studies (15 298 patients) with the highest quality was 12.8% (95% CI 11.4-14.2; I 2 = 86.1%). Treatment-related mortality (56 patients) has a pooled incidence of 0.7% (95% CI 0.0-1.4; I 2 = 0.0%).

Conclusion: The recurrence rate of chronic subdural hematoma treated by burr-hole surgery and postoperative drainage is 12.8%.

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Figures

FIGURE 1.
FIGURE 1.
Computed tomography scan of a left-sided chronic subdural hematoma in an axial and coronal plane.
FIGURE 2.
FIGURE 2.
Computed tomography scan of a right-sided acute-on-chronic subdural hematoma in an axial and coronal plane.
FIGURE 3.
FIGURE 3.
Computed tomography scan of a bilateral subdural hygroma in an axial and coronal plane.
FIGURE 4.
FIGURE 4.
Flow chart diagram of literature search and selection.
FIGURE 5.
FIGURE 5.
Funnel plot of recurrence rates reported in 189 included studies (36 971 patients) for evaluating bias. The plot shows that the included studies in this meta-analysis do not seem to be symmetrically ranged around the pooled incidence of recurrence, shown by the smaller dashed line. This could be due to the relatively high heterogeneity reported in this study.
See this image and copyright information in PMC

Comment in

References

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