Subdural Drain versus Subdural Evacuating Port System for the Treatment of Nonacute Subdural Hematomas: A Single-Center Retrospective Cohort Study.

Background: Subdural drain (SDD) and Subdural Evacuating Port System (SEPS) are bedside options for management of nonacute subdural hematomas (SDHs). These interventions have not been compared with each other. Our objective is to compare the need for second bedside procedure, need for craniotomy, complication rate, and other outcomes related to bedside drainage of SDH with SDD or SEPS. We hypothesized that SDD would be associated with superior outcomes to SEPS.

Methods: Database queries and direct patient chart reviews were used to gather patient data. t-Tests, Fisher exact tests, and proportional odds models were performed.

Results: Of 41 SDDs and 25 SEPS, baseline characteristics were similar except more isodense SDHs were present in SDD (P = 0.0312). SEPS was associated with significant risk of requiring a second bedside procedure (odds ratio, 3.2381; 99% confidence interval, 1.0345-10.1355) relative to SDD. Need for craniotomy did not differ between groups (12.1% SDD vs. 16% SEPS; P = 0.721). The complication rate was similar between groups (2.4% SDD vs. 12% SEPS; P = 0.1484). Symptom resolution, condition at latest follow-up, and posthospital disposition were similar between groups, but SEPS was associated with longer intensive care unit and total hospital length of stay (P = 0.02 and 0.04, respectively).

Conclusions: SEPS was associated with higher risk for need of second bedside procedure and longer intensive care unit and hospital length of stay than SDD, although not increased need for craniotomy. Additional studies are needed to confirm our findings and determine if SDD may be more effective than SEPS for the treatment of nonacute SDH.