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The Danish chronic subdural hematoma study—predicting recurrence of chronic subdural hematoma

  • Original Article - Neurosurgery general
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Abstract

Background

An increasing incidence of chronic subdural hematoma (CSDH) and an unchanging high recurrence rate of 10–20% call for individualized treatment. The aim of this study was to establish individualized prediction models for the risk of recurrence treating death as a competing risk.

Methods

A retrospective national cohort of unilateral CSDH was included for analysis. Using competing risk survival analysis, we tested whether available covariates were associated with the risk of recurrence. We further established a pre- and a postoperative prediction model, where predictors were chosen using a LASSO approach. The models were visualized in nomograms. Predictive performance was evaluated by c index and calibrations plots.

Results

A total of 763 patients with surgically evacuated unilateral CSDH were included for analysis. The recurrence rate was 14% while 12% of patients died during follow-up (1 year). In our association model, hematoma size, drain type, drainage time, presence of complications, and Glasgow Coma Score were significantly associated to recurrence. Subdural drain was associated with a lower recurrence risk than subgaleal drain. The preoperative model included hematoma size, hematoma density, and history of hypertension. The postoperative model included further drain type, drainage time, and surgical complications.

Conclusion

The nomograms allow easy assessment of the recurrence risk for the individual patient, providing a better possibility for individual adjustment of treatment and follow-up. The predictive performance indicates that significant unaccounted or unknown factors still remain. The association test found passive subdural drain superior to passive subgaleal drain in minimizing the risk of CSDH recurrence.

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Financial support

Nina Christine Andersen-Ranberg received grants from the following foundations: Rigshospitalet research foundation and the Hetland Olsen foundation to cover monthly salary. Expenses to statistical analysis were covered by the department of Neurosurgery, Rigshospitalet.

Funding

Rigshospitalet Research Foundation and the Hetland Olsen Foundation provided financial support to cover monthly salary. Expenses to statistical analysis were covered by the department of Neurosurgery, Rigshospitalet.

The sponsors had no role in the design or conduct of this research.

Author information

Author notes

  1. Nina Christine Andersen-Ranberg and Birgit Debrabant contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Rigshospitalet University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark

    Nina Christine Andersen-Ranberg & Kåre Fugleholm

  2. Epidemiology and Biostatistics, Department of Public Health, University of Southern Denmark, Odense, Denmark

    Birgit Debrabant

  3. Department of Neurosurgery, Odense University Hospital, Odense, Denmark

    Frantz Rom Poulsen

  4. Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark

    Bo Bergholt

  5. Department of Neurosurgery, Aalborg University Hospital, Aalborg, Denmark

    Torben Hundsholt

Authors
  1. Nina Christine Andersen-Ranberg
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  2. Birgit Debrabant
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  3. Frantz Rom Poulsen
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  4. Bo Bergholt
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  5. Torben Hundsholt
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  6. Kåre Fugleholm
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Correspondence to Nina Christine Andersen-Ranberg.

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Andersen-Ranberg, N.C., Debrabant, B., Poulsen, F.R. et al. The Danish chronic subdural hematoma study—predicting recurrence of chronic subdural hematoma. Acta Neurochir 161, 885–894 (2019). https://doi.org/10.1007/s00701-019-03858-9

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  • DOI: https://doi.org/10.1007/s00701-019-03858-9

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