Post-Residency Survey Reveals Critical Education Issues: Results of the Council of State Neurosurgical Society (CSNS) Survey: 901.

INTRODUCTION: Chronic subdural hematoma (CSDH) is a cause of significant morbidity and mortality which is often amenable to surgical drainage. The majority of patients recover rapidly after surgical intervention, but 5% to 30% experience recurrence. Although the use of drains after burr hole evacuation may lower recurrence, they are not used routinely because of a lack of evidence showing efficacy and a concern for increasing surgical morbidity. The aim of this study was to investigate the use of drains in reducing recurrence rates, and their influence on clinical outcome for those presenting with a CSDH. METHODS: Between November 2004 and 2007, 215 patients were randomized: 108 were assigned to drain and 107 to no drain. The primary outcome was recurrence requiring redrainage. The secondary outcomes included mortality at 30 days and 6 months, modified Rankin scale (mRS) score at the time of discharge and 6 months. RESULTS: The CSDH recurrence rate was 10 out of 108 (9.3%) in the drain group and 26 out of 107 (24%) in the non-drain group (χ2, P 0.003). At 6 months, the mortality rate was 10 out of 106 (9.4%) and 19 out of 105 (18.1%), respectively (χ2, P = 0.042). A greater proportion had favorable mRS scores (0–3) in the drain group at the time of discharge (81 out of 97 [84%] versus 64 out of 95 [67%], χ2, P = 0.009). In addition, a significantly greater proportion of patients with a drain were discharged with a Glasgow Coma Scale score of 15 (76 out of 94 [81%] versus 62 out of 97 [63%], χ2, P = 0.007) and without a neurological deficit (47 out of 93 [51%] versus 63 out of 96 [66%]; χ2, P = 0.036). There was no difference in the rate of inpatient medical or surgical complications between the study groups. CONCLUSION: The use of drain with burr hole drainage reduces the recurrence rate for CSDH and is associated with better functional status at discharge and lower rates of mortality at 6 months.