Use of Novel Automated Active Irrigation With Drainage Versus Passive Drainage Alone for Chronic Subdural Hematoma-A Propensity Score-Matched Comparative Study With Volumetric Analysis

Ammad A Baig; Ryan M Hess; Asham Khan; Justin M Cappuzzo; Ryan C Turner; Eisa Hashmi; Amade Bregy; Cathleen C Kuo; Elizabeth Nyabuto; Aditya D Goyal; Jason M Davies; Elad I Levy; Adnan H Siddiqui

doi:10.1227/ons.0000000000000630

Use of Novel Automated Active Irrigation With Drainage Versus Passive Drainage Alone for Chronic Subdural Hematoma-A Propensity Score-Matched Comparative Study With Volumetric Analysis

Oper Neurosurg (Hagerstown). 2023 Jun 1;24(6):630-640. doi: 10.1227/ons.0000000000000630. Epub 2023 Feb 1.

Authors

Ammad A Baig^{1

2}, Ryan M Hess^{1

2}, Asham Khan^{1

2}, Justin M Cappuzzo^{1

2}, Ryan C Turner^{1

2}, Eisa Hashmi^{2

3}, Amade Bregy^{1

2}, Cathleen C Kuo^{2

3}, Elizabeth Nyabuto^{1

2}, Aditya D Goyal², Jason M Davies^{1

2

4

5

6}, Elad I Levy^{1

2

5

6

7}, Adnan H Siddiqui^{1

2

5

6

7}

Affiliations

¹ Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
² Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA.
³ Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
⁴ Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
⁵ Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA.
⁶ Jacobs Institute, Buffalo, New York, USA.
⁷ Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.

PMID: 36723341
DOI: 10.1227/ons.0000000000000630

Abstract

Background: Passive drainage post-surgical evacuation of symptomatic chronic subdural hematoma (cSDH) is currently standard of care. High rates of infection, drain occlusion, and recurrence are associated complications.

Objective: To explore the use of a novel double-lumen active automated irrigation and aspiration system, IRRAflow (IRRAS), for patients with cSDH and compared procedural and clinical outcomes against passive drainage alone with propensity score matching (PSM) and volumetric analysis.

Methods: A prospectively maintained database was retrospectively searched for consecutive patients presenting with cSDH. One-to-one PSM of covariates (including baseline comorbidities and presentation hematoma volume) in active and passive irrigation groups was performed to adjust for treatment selection bias. Rates of hematoma clearance, catheter-related occlusion, and infection; number of revisions; and length of hospital stay were recorded.

Results: This study included 55 patients: active continuous irrigation-drainage-21 (21 post-PSM) and passive drainage-34 (21 post-PSM). For PSM groups, a significantly higher rate of hematoma clearance was obtained in the active irrigation-drainage group (0.5 ± 0.4 vs 0.4 ± 0.5 mL/day) and in the passive drainage group; odds ratio (OR) = 1.291 (CI: 1.062-1.570, P = .002) and a significantly lower rate of catheter-related infections (OR = 0.051; CI: 0.004-0.697, P = .039). A nonsignificantly lower hematoma expansion rate at discharge was noted in the active irrigation-drainage group (4.8% vs 23.8%; OR = 0.127; P = .186). No statistical difference in all-cause in-hospital mortality or discharge Glasgow Coma Scale score was observed between groups.

Conclusion: Active and automated continuous irrigation plus drainage after cSDH surgical evacuation resulted in faster hematoma clearance and led to favorable clinical outcomes and low complication and revision rates compared with passive irrigation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Drainage / methods
Hematoma, Subdural, Chronic* / surgery
Humans
Propensity Score
Retrospective Studies
Trephining / methods