Artificial cerebrospinal fluid use during burr-hole surgery and reoperation rate in patients with chronic subdural hematoma: an analysis using a nationwide inpatient database

Shibahashi, Keita; Ohbe, Hiroyuki; Yasunaga, Hideo

doi:10.1007/s00701-023-05570-1

Cited by 1 publication

(7 citation statements)

References 24 publications

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“…After removing 594 duplicates, we screened the remaining 943 publications based on article type, title, and abstracts and excluded 936 unrelated publications, leaving seven studies. We meticulously evaluated the seven publications for potential eligibility (12,15,16,21,(29)(30)(31), and all met inclusion criteria. Subsequently, we manually searched the Chinese database for relevant studies and found four additional studies (32)(33)(34)(35) that met our inclusion criteria.…”

Section: Study Selectionmentioning

confidence: 99%

“…Subsequently, we manually searched the Chinese database for relevant studies and found four additional studies (32)(33)(34)(35) that met our inclusion criteria. In summary, we included a total of 11 studies (12,15,16,21,(29)(30)(31)(32)(33)(34)(35) in our systematic review and meta-analysis (Figure 1).…”

Section: Study Selectionmentioning

confidence: 99%

“…The 11 studies included in this systematic review and metaanalysis were published between 2012 and 2023. Among them, four articles were RCT (30,31,33,34), and the remaining seven articles (12,15,16,21,29,32,35) were non-RCTs. The studies were conducted in China (n = 4), Sweden (n = 2), and Japan (n = 5), with a total of 29,846 patients included.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

“…One study (29) utilized a 1:1 propensity score matching (PSM) method to balance the influence of potential confounding factors, resulting in the inclusion of 27,788 patients in the analysis. 10 studies (12,15,16,21,(29)(30)(31)(32)(33)(34) underwent burr-hole surgery with drainage or irrigation. One study (35) underwent YL-1type hard-channel drilling drainage.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

“…Seven studies (12,15,16,29,31,33,34) looked at the effect of different irrigation fluids on postoperative recurrence, including 28,963 patients. Among them, 14,470 cases were in the ACF group with 916 patients of recurrence and 14,493 cases in the NS group with 1,060 patients of recurrence.…”

Section: Effect Of Acf On Recurrencementioning

confidence: 99%

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Intraoperative irrigation of artificial cerebrospinal fluid and temperature of irrigation fluid for chronic subdural hematoma: a systematic review and meta-analysis

Huang

2023

Front. Neurol.

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PurposeTo systematically review the different types of irrigation fluid and the different temperatures of irrigation fluid on postoperative recurrence rates in the evacuation of chronic subdural hematoma (CSDH).MethodsWe conducted a comprehensive search of electronic databases, including PubMed, Embase, the Cochrane Library, the China National Knowledge Infrastructure (CNKI), WanFang, the Chinese VIP Information (VIP), and China Biology Medicine (CBM), and reference lists of relevant studies to identify all eligible studies. Two reviewers independently screened the titles and abstracts for inclusion, and the full-text articles were assessed for eligibility based on predetermined inclusion and exclusion criteria. Data were extracted using a standardized form, and the quality of the studies was assessed using a risk of bias tool. Meta-analyses were performed using a fixed-or random-effects model, and heterogeneity was assessed using the I2 statistic. The primary endpoint was the postoperative recurrence rate.ResultsAfter stringent screening, a total of 11 studies were identified, including six English publications, four Chinese publications, and one Japanese publication, involving a population of 29,846 patients. Our meta-analysis provides evidence that artificial cerebrospinal fluid (ACF) could decrease the post-operative recurrence rate by 47% after the evacuation of CSDH when compared to normal saline (NS) [(odds ratio) OR 0.53, 95% confidence intervals (CI): 0.31–0.90, p = 0.02, I2 = 67%]. Besides, the irrigation fluid at body temperature could decrease the postoperative recurrence rate of CSDH by 64% when compared to room temperature (OR = 0.36, 95% CI = 0.22–0.59, p < 0.0001, I2 = 0%).ConclusionOur analysis revealed significant difference in the choice of irrigation fluid for CSDH surgery. Notably, we found that irrigation with fluid at body temperature demonstrated superiority over irrigation with fluid at room temperature, resulting in fewer instances of recurrence. This straightforward technique is both safe and widely available, providing an opportunity to optimize outcomes for patients with CSDH. Our findings suggest that the use of body-temperature NS or ACF of room temperature during operation should be considered a standard of procedure in CSDH surgery. Nevertheless, whether the different temperature of ACF could be considered a standard of procedure in CSDH surgery still need high-quality RCTs to further identify.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/; Identifier CRD42023424344.

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