Analysis of the predictive factors of postoperative recurrence in patients with unilateral chronic subdural hematoma

doi:10.3877/cma.j.issn.2095-9141.2021.06.008

Abstract

Abstract:

Objective

To explore risk factors and predictive value of postoperative recurrence in patients with unilateral chronic subdural hematoma (CSDH).

Methods

Clinical data of 108 patients with unilateral CSDH admitted to Neurosurgery Department of Fuyang Fifth People’s Hospital from December 2017 to August 2020 were retrospectively analyzed. According to the CSDH recurrence within 3 months after operation, the patients were divided into the group of recurrence (n=13) and the group of non-recurrence (n=95). Univariate and multivariate binary Logistic regression analysis were applied to analyze the independent risk factors of recurrence. The receiver operating characteristic (ROC) curve was used to investigate the predictive value of the risk factors.

Results

Multivariate binary logistic regression analysis showed that ipsilateral width of subdural space at 7th day after operation (OR=1.336, 95%CI: 1.126-1.585, P=0.001), maximum CT value of hematoma (OR=1.221, 95%CI: 1.071-1.393, P=0.003) was independently correlated with recurrence. The area under the curve (AUC) of those independent risk factors were 0.806 (95%CI: 0.781-0.876, P<0.001) and 0.738 (95%CI: 0.645-0.818, P<0.001), respectively. The AUC of the risk factors combined to predict recurrence was 0.904 (95%CI: 0.832-0.952, P<0.001).

Conclusion

The width of subdural space at 7^th day after operation and the maximum CT value of hematoma are independent risk factors for the recurrence of unilateral CSDH, the combined application of the two has a good predictive value for the recurrence of postoperative hematoma

Key words: Chronic subdural hematoma, Width of subdural space, Recurrence, Predictive value, Receiver operating characteristic curve

Ruhai Wang, Haicheng Hu, Chao Han, Qiang Yu, Haofeng Huang. Analysis of the predictive factors of postoperative recurrence in patients with unilateral chronic subdural hematoma[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2021, 07(06): 359-363.

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References 21

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因素		复发组（n=13）	未复发组（n=95）	χ²/t/U值	P值
性别[例（%）]				0.156	0.693
	男性	11（84.62）	76（80.00）
	女性	2（15.38）	19（20.00）
年龄（岁，±s）		74.38±8.37	70.35±11.30	1.241	0.217
高血压病[例（%）]				4.969	0.026
	是	9（69.23）	35（36.84）
	否	4（30.77）	60（65.26）
糖尿病[例（%）]				2.116	0.146
	是	4（30.77）	14（14.74）
	否	9（69.23）	81（85.26）
神经功能障碍[例（%）]				0.688	0.407
	是	8（61.54）	69（72.63）
	否	5（38.46）	26（27.37）
GCS评分（分，±s）		14.54±0.97	14.48±1.53	0.124	0.901
术前血肿最大CT值（Hu，±s）		48.62±6.21	41.35±9.34	2.718	0.008
术前血肿厚度（mm，±s）		22.45±6.86	22.01±5.79	0.253	0.801
术中置管长度（cm，±s）		4.31±0.85	4.25±1.17	0.179	0.858
术后引流量[mL，M（P₂₅，P₇₅）]		117（82，155）	112（50，250）	-0.066	0.947
术后7 d颅内积气[例（%）]				0.077	0.782
	是	7（53.85）	55（57.89）
	否	6（46.15）	40（42.11）
术后7 d硬膜下间隙宽度（mm，±s）		17.26±6.19	10.52±5.42	4.138	<0.001

因素		复发组（n=13）	未复发组（n=95）	χ²/t/U值	P值
性别[例（%）]				0.156	0.693
	男性	11（84.62）	76（80.00）
	女性	2（15.38）	19（20.00）
年龄（岁，±s）		74.38±8.37	70.35±11.30	1.241	0.217
高血压病[例（%）]				4.969	0.026
	是	9（69.23）	35（36.84）
	否	4（30.77）	60（65.26）
糖尿病[例（%）]				2.116	0.146
	是	4（30.77）	14（14.74）
	否	9（69.23）	81（85.26）
神经功能障碍[例（%）]				0.688	0.407
	是	8（61.54）	69（72.63）
	否	5（38.46）	26（27.37）
GCS评分（分，±s）		14.54±0.97	14.48±1.53	0.124	0.901
术前血肿最大CT值（Hu，±s）		48.62±6.21	41.35±9.34	2.718	0.008
术前血肿厚度（mm，±s）		22.45±6.86	22.01±5.79	0.253	0.801
术中置管长度（cm，±s）		4.31±0.85	4.25±1.17	0.179	0.858
术后引流量[mL，M（P₂₅，P₇₅）]		117（82，155）	112（50，250）	-0.066	0.947
术后7 d颅内积气[例（%）]				0.077	0.782
	是	7（53.85）	55（57.89）
	否	6（46.15）	40（42.11）
术后7 d硬膜下间隙宽度（mm，±s）		17.26±6.19	10.52±5.42	4.138	<0.001

指标	回归系数	标准误	Wald χ²值	OR值	95%CI	P值
高血压病	0.599	0.760	0.621	1.820	0.410~8.079	0.431
术前血肿最大CT值	0.200	0.067	8.866	1.221	1.071~1.393	0.003
术后7 d硬膜下间隙宽度	0.290	0.087	11.007	1.336	1.126~1.585	0.001

指标	回归系数	标准误	Wald χ²值	OR值	95%CI	P值
高血压病	0.599	0.760	0.621	1.820	0.410~8.079	0.431
术前血肿最大CT值	0.200	0.067	8.866	1.221	1.071~1.393	0.003
术后7 d硬膜下间隙宽度	0.290	0.087	11.007	1.336	1.126~1.585	0.001

指标	截断值	灵敏度（%）	特异度（%）	曲线下面积	95%CI	P值
术前血肿最大CT值	47	69.23	67.37	0.738	0.645~0.818	<0.001
术后7 d硬膜下间隙宽度	13	92.31	69.47	0.806	0.781~0.876	<0.001
联合预测	-	95.79	30.77	0.904	0.832~0.952	<0.001

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