First-line management of chronic subdural hematoma with the subdural evacuating port system: Institutional experience and predictors of outcomes

Hoffman, Haydn; Ziechmann, Robert; Beutler, Timothy; Verhave, Brendon; Chin, Lawrence S.

doi:10.1016/j.jocn.2018.01.068

Cited by 13 publications

(9 citation statements)

References 22 publications

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“…16,23,24 Given these findings, subsequent SEPS studies have restricted their study populations to patients with cSDH and found similar rates of recurrence in this subgroup (15%-24%) as in our series (12.5%). 4,13,15,17,20 Acute and subacute hematomas treated with SEPS in our series trended toward having an increased 24-hour residual hematoma volume compared to chronic hematomas. Combined with our additional finding that SEPS was significantly less effective than craniotomy at preventing recurrence in acute and subacute hematomas, our data support the more recent, SEPS-specific, literature and cautions its use in more emergent, aSDH cases.…”

Section: Discussionmentioning

confidence: 62%

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, our study period was limited to 5 years; more longitudinal studies have shown that cumulative physician experience with SEPS placement over time significantly lowers corresponding recurrence rates. 15,17 Another key limitation is the variation in the extent of follow-up between the 2 intervention groups as the craniotomy group experienced nearly double the length of follow-up as the SEPS group. Although this may be reflective of the observed increased postoperative seizure rate or the general invasiveness of craniotomy requiring longer recovery time, it is important to consider that observed recurrence rates in the SEPS group may be confounded by a shorter follow-up period.…”

Section: Discussionmentioning

confidence: 99%

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

Section: Introductionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Golub

Ashayeri

Dogra

et al. 2020

The Neurohospitalist

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Background: There remains no consensus on the optimal primary intervention for subdural hematoma (SDH). Although historically favored, craniotomy carries substantial morbidity and incurs significant costs. Contrastingly, the subdural evacuating port system (SEPS) is a minimally invasive bedside procedure. We assessed the benefits of SEPS over traditional craniotomy for SDH evacuation. Methods: A single-center retrospective cohort study of SDH patients receiving craniotomy or SEPS between 2012 and 2017 was performed. Information regarding demographics, medical history, presentation, surgical outcomes, cost, and complications was collected. Pre- and postoperative hematoma volumes were calculated using 3D image segmentation using Vitrea software. Multivariate regression models were employed to assess the influence of intervention choice. Results: Of 107 patients, 68 underwent craniotomy and 39 underwent SEPS. There were no differences in age, sex, blood thinner use, platelet count, INR, hematoma lateralization, age, volume, or midline shift at presentation between intervention groups. Although there was no difference in percent residual hematoma volume 24-hour postintervention (44.1% vs 45.1%, P = .894), SEPS was associated with lower hospitalization costs ($108 391 vs $166 318, * P = .002), shorter length of stay (4.0 vs 5.8 days, * P = .0002), and fewer postoperative seizures (2.6% vs 17.7%, * P = .048). Reoperation rate was higher after SEPS overall (33.3% vs 13.2%, * P = .048) but comparable to craniotomy in chronic SDH (12.50% vs 7.69%, P = 1.000). Conclusion: In this retrospective cohort, SEPS was noninferior to craniotomy at reducing SDH hematoma volume. The SEPS procedure was also associated with decreased length of stay hospitalization costs, and postoperative seizures and demonstrated a comparable recurrence rate to craniotomy for chronic SDH in particular.

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