Surgical Closed Suction Drain Use After Craniotomy for Evacuation of Supratentorial Epidural Hematomas: A Case Series of Radiographic and Clinical Outcomes.

Abstract

Surgical closed suction drain (SCSDs) are used in a variety of surgical disciplines to prevent postoperative fluid collections. Use of SCSDs has not been well studied in the neurosurgical literature. Practice patterns have varied within our institution with respect to SCSDs after craniotomies for neurotrauma. In this study we describe SCSD use for patients undergoing evacuation of supratentorial epidural hematomas (EDHs) and examine the effect on patient outcomes and length of hospital stay. We performed a retrospective review of craniotomies for supratentorial EDH performed at our Level I trauma center between May 2015 and May 2018. Imaging and clinical data were obtained from chart review. Fifty-two patients with EDH received operations from 8 attending surgeons. The number of drains used was 0 or 1 in 36 cases and 2 or more in 16 cases. Drain location was subgaleal in 25 cases, epidural in 8 cases, and both subgaleal and epidural in 13 cases. Attending preference (P < 0.001) but not hematoma size was associated with use of an epidural drain and use of 2 or more drains. After controlling for age, initial neurologic exam, and presence of other injuries, use of more drains was associated with longer intensive care unit lengths of stay. Drain use pattern was not associated with patient outcome measures, and no return to the operating room was necessary for residual or recurrent EDH. Use of fewer SCSDs did not affect radiographic outcome after evacuation of epidural hematomas but was associated with decreased intensive care unit length of stay.