Intravenous Fluid Administration May Improve Post-Operative Course of Patients with Chronic Subdural Hematoma: A Retrospective Study

Background: The treatment of chronic subdural hematoma (cSDH) is still charged of significant risk of hematoma recurrence. Patient-related predictors and the surgical procedures themselves have been addressed in many studies. In contrast, postoperative management has infrequently been subjected to detailed analysis. Moreover variable intravenous fluid administration (IFA) was not reported in literature till now in the context of cSDH treatment. Methodology/Principal Findings: A total of 45 patients with cSDH were operated in our department via two burr hole craniostomy within one calendar year. Downward drainage was routinely left in hematoma cavity for a one day. Independent variables selected for the analysis were related to various aspects of patient management, including IFA. Two dependent variables were chosen as measure of clinical course: the rate of hematoma recurrence (RHR) and neurological status at discharge from hospital expressed in points of Glasgow Outcome Scale (GOS). Univariate and multivariate regression analyses were performed. Hematoma recurrence with subsequent evacuation occurred in 7 (15%) patients. Univariate regression analysis revealed that length of IFA after surgery influenced both dependent variables: RHR (p = 0.045) and GOS (p = 0.023). Multivariate regression performed by backward elimination method confirmed that IFA is a sole independent factor influencing RHR. Post hoc dichotomous division of patients revealed that those receiving at least 2000 ml/day over 3 day period revealed lower RHR than the group with less intensive IFA. (p = 0.031)

Multivariate regression analysis: summary of backward independent variable elimination process for dependent variable GOS.

<p>Combination of effects IFA and Na remained in model; LR = 9.7944; <b>p = 0.0075</b>.</p><p>Significant values are featured with bold font. Abbreviations: GCS: Glasgow Coma Scale, ND: Neurological Deficit, Na: Natrium, Hct: Hematocrit, ACP: abnormal coagulation profile, HT: Thickness of Hematoma, BLH: Bilateral Hematoma, IFA: Intravenous Fluid Administration, GOS: Glasgow Outcome Scale.</p

Description of independent variables selected for regression analysis.

<p>Description of independent variables selected for regression analysis.</p

Univariate regression analysis.

<p>Significant values are featured with bold font. Abbreviations: GCS: Glasgow Coma Scale, ND: Neurological Deficit, Na: Natrium, Hct: Hematocrit, ACP: abnormal coagulation profile, HT: Thickness of Hematoma, BLH: Bilateral Hematoma, IFA: Intravenous Fluid Administration, RHR: Rate of Hematoma Recurrence, GOS: Glasgow Outcome Scale.</p

Supplementary univariate regression analysis of IFA factor.

<p>Significant values are featured with bold font. Abbreviations: FF: Full Fluids, HDFA: High-Dose Fluid Administration, LDFA: Low-Dose Fluid Administration, RHR: Rate of Hematoma Recurrence, GOS: Glasgow Outcome Scale.</p

Multivariate regression analysis: summary of backward independent variable elimination process for dependent variable RHR.

<p>Effect IFA remained in model; LR = 4.021; <b>p = 0.0449</b>.</p><p>Significant values are featured with bold font. Abbreviations: GCS: Glasgow Coma Scale, ND: Neurological Deficit, Na: Natrium, Hct: Hematocrit, ACP: abnormal coagulation profile, HT: Thickness of Hematoma, BLH: Bilateral Hematoma, IFA: Intravenous Fluid Administration, RHR: Rate of Hematoma Recurrence.</p