Treatment of chronic subdural hematomas with subdural evacuating port system placement in the intensive care unit: evolution of practice and comparison with bur hole evacuation in the operating room

Abstract

OBJECTIVE The aims of this study were to evaluate a multiyear experience with subdural evacuating port system (SEPS) placement for chronic subdural hematoma (cSDH) in the intensive care unit at a tertiary neurosurgical center and to compare SEPS placement with bur hole evacuation in the operating room. METHODS All cases of cSDH evacuation were captured over a 7-year period at a tertiary neurosurgical center within an integrated health care delivery system. The authors compared the performance characteristics of SEPS and bur hole placement with respect to recurrence rates, change in recurrence rates over time, complications, length of stay, discharge disposition, and mortality rates. RESULTS A total of 371 SEPS cases and 659 bur hole cases were performed (n = 1030). The use of bedside SEPS placement for cSDH treatment increased over the 7-year period, from 14% to 80% of cases. Reoperation within 6 months was higher for the SEPS (15.6%) than for bur hole drainage (9.1%) across the full 7-year period (p = 0.002). This observed overall difference was due to a higher rate of reoperation during the same hospitalization (7.0% for SEPS vs 3.2% for bur hole; p = 0.008). Over time, as the SEPS procedure became more common and modifications of the SEPS technique were introduced, the rate of in-hospital reoperation after SEPS decreased to 3.3% (p = 0.02 for trend), and the difference between SEPS and bur hole recurrence was no longer significant (p = 0.70). Complications were uncommon and were similar between the groups. CONCLUSIONS Overall performance characteristics of bedside SEPS and bur hole drainage in the operating room were similar. Modifications to the SEPS technique over time were associated with a reduced reoperation rate.

Benefits of the Subdural Evacuating Port System (SEPS) Procedure Over Traditional Craniotomy for Subdural Hematoma Evacuation

“…18 With the advent and commercialization of drainage systems, however, kits such as the SEPS have gained popularity and are increasingly described in the literature, particularly over the past 5 years. 4,15,17,19,20 Bedside procedures such as the SEPS provide an opportunity to avoid general anesthesia, and its hermetically sealed mechanism decreases the risk of infection—both critical advantages when treating a primarily elderly population who tend to be poor surgical candidates. 11 Our retrospective study corroborates the existing literature suggesting that the SEPS is associated with a low postoperative infection and comorbidity rate with a 0% infection rate observed in our study across nearly 40 patients.…”

“…11 Our retrospective study corroborates the existing literature suggesting that the SEPS is associated with a low postoperative infection and comorbidity rate with a 0% infection rate observed in our study across nearly 40 patients. 14,15…”

“…16 As a consequence, the vast majority of existing observational data on the SEPS has been limited to the cSDH population. 13,15,17…”

“…[11][12][13] Several series have demonstrated the positive safety profile of the bedside SEPS, especially after a period of prolonged institutional experience, but few discuss the comparative effectiveness of SEPS versus alternative intervention. [13][14][15] Additionally, it has been suggested that the SEPS procedure is less likely to result in reoperation when treating collections that are hypodense on computed tomography (CT; cSDHs). 16 As a consequence, the vast majority of existing observational data on the SEPS has been limited to the cSDH population.…”

“…16 As a consequence, the vast majority of existing observational data on the SEPS has been limited to the cSDH population. 13,15,17 In this study, we analyzed a single institution's experience with SEPS compared to craniotomy across all SDH subtypes. In addition to examining clinical outcomes such as hematoma volume reduction and postoperative complications (including need for reoperation), cost-effectiveness factors such as cost of hospitalization and length of stay were also studied.…”