Risk factors for developing subdural hematoma: a registry-based study in 1457 patients with shunted idiopathic normal pressure hydrocephalusVisa övriga samt affilieringar
2021 (Engelska)Ingår i: Journal of Neurosurgery, ISSN 0022-3085, E-ISSN 1933-0693, Vol. 134, nr 2, s. 668-677Artikel i tidskrift (Refereegranskat) Published
Abstract [en]
OBJECTIVE: Subdural hematomas and hygromas (SDHs) are common complications in idiopathic normal pressure hydrocephalus (iNPH) patients with shunts. In this registry-based study, patients with shunted iNPH were screened nationwide to identify perioperative variables that may increase the risk of SDH.
METHODS: The Swedish Hydrocephalus Quality Registry was reviewed for iNPH patients who had undergone shunt surgery in Sweden in 2004-2014. Potential risk factors for SDH were recorded preoperatively and 3 months after surgery. Drug prescriptions were identified from a national pharmacy database. Patients who developed SDHs were compared with those without SDHs.
RESULTS: The study population consisted of 1457 patients, 152 (10.4%) of whom developed an SDH. Men developed an SDH more often than women (OR 2.084, 95% CI 1.421-3.058, p < 0.001). Patients on platelet aggregation inhibitors developed an SDH more often than those who were not (OR 1.733, 95% CI 1.236-2.431, p = 0.001). At surgery, shunt opening pressures had been set 5.9 mm H2O lower in the SDH group than in the no-SDH group (109.6 ± 24.1 vs 115.5 ± 25.4 mm H2O, respectively, p = 0.009). Antisiphoning devices (ASDs) were used in 892 patients but did not prevent SDH. Mean opening pressures at surgery and the follow-up were lower with shunts with an ASD, without causing more SDHs. No other differences were seen between the groups.
CONCLUSIONS: iNPH patients in this study were diagnosed and operated on in routine practice; thus, the results represent everyday care. Male sex, antiplatelet medication, and a lower opening pressure at surgery were risk factors for SDH. Physical status and comorbidity were not. ASD did not prevent SDH, but a shunt with an ASD allowed a lower opening pressure without causing more SDHs.
Ort, förlag, år, upplaga, sidor
American Association of Neurological Surgeons , 2021. Vol. 134, nr 2, s. 668-677
Nyckelord [sv]
hydrocephalus, normal pressure, hygroma, chronic subdural hematoma, cerebrospinal shunt, complications
Nationell ämneskategori
Neurologi
Forskningsämne
neurokirurgi; neurologi
Identifikatorer
URN: urn:nbn:se:umu:diva-167468DOI: 10.3171/2019.10.JNS191223ISI: 000646417500005PubMedID: 31923893Scopus ID: 2-s2.0-85091682031OAI: oai:DiVA.org:umu-167468DiVA, id: diva2:1387696
Anmärkning
Abbreviations: ASD = antisiphoning device; CSF = cerebrospinal fluid; iNPH = idiopathic normal pressure hydrocephalus; NSAID = nonsteroidal anti-inflammatory drug; SDH = subdural hematoma/hygroma; SHQR = Swedish Hydrocephalus Quality Registry; SPDR = Swedish Prescribed Drug Register.
2020-01-222020-01-222023-05-03Bibliografiskt granskad