Analysis And Evaluation Of Recurrence Factors After Chronic Subdural Hematoma Surgery

Objective: To investigate the relationship between various factors and recurrence after drilling and drainage of chronic subdural hematoma and its evaluation significance.Methods: Data on 290 cases admitted to the Department of Neurosurgery of the First Affiliated Hospital of Jiamusi University in the past 4 years,including: general conditions(age,gender),clinical symptoms,scored by MCS grade,GCS score on admission),past medical history(hypertension,diabetes,cerebral infarction,trauma),anticoagulant use,degree of midline shift,serum albumin,inflammatory cells(lymphocytes,neutrophils,eosinophilia),hematoma typing(low,etc,etc,high,confounding density),hematoma internal separation,single bilateral,intraoperative hematoma clearance,and postoperative oral avatoratin.Patients were divided into good and relapsed groups according to whether CSDH recurred within 3 months after surgery.SPSS 26.0 software used corresponding test methods(chi-metric and non-parametric test)to compare the difference between case data;Spearman to analyze the correlation between factors and recurrence;independent risk factors of recurrence by multivariate Logistic regression analysis and collinear diagnosis;and ROC curve to evaluate the prediction ability of the related factors on postoperative recurrence.Results:Univariate analysis showed that two groups of patients in age,hypertension,diabetes,cerebral infarction,have a clear history of trauma,preoperative taking anticoagulants,postoperative arvastatatin,hematoma separation,intraoperative hematoma clearance,hematoma density classification,degree of midline shift,lymphocytes in peripheral blood,neutrophils,eosinophil count,serum albumin difference with statistical significance(P <0.05);The results of Spearman analysis showed that:(1)hypertension,diabetes,cerebral infarction,clear history of trauma,preoperative anticoagulant drugs,hematoma separation,intraoperative hematoma clearance,hematoma density,and the degree of midline shift(P <0.05,r> 0)played a certain role in the postoperative recurrence of CSDH patients;(2)The lymphocyte,neutrophil and eosinophil counts(P <0.05,r> 0)will increase to different degrees;(3)However,postoperative avatastatin and high content of serum albumin(P<0.05,r <0)had an inhibitory effect on postoperative recurrence.After Logistic regression analysis and adjustment for collinearity diagnosis,it was concluded that preoperative anticoagulant drugs,hematoma separation,hematoma density,peripheral blood eosinophil count and intraoperative hematoma clearance were independent risk factors after CSDH(P <0.05 and VIF <5).All(P <0.05)relapse-related factors,including independent risk factors,were later grouped,According to the ROC curve analysis,AUC of anticoagulant was0.730(95%CI:0.627-0.832 and P <0.001),AUC of hematoma was0.641(95%CI:0.539-0.744 and P=0.007),AUC of hematoma was0.835(95%CI:0.749-0.922 and P <0.001),and AUC of eosinophil count was0.754(95%CI:0.655-0.854 and P <0.001),the AUC of hematoma clearance for predicting postoperative recurrence was 0.694(95%CI:0.592-0.795,P <0.001),Independent risk factors were all somewhat predictive for postoperative recurrence,Moreover,hematoma septation,preoperative anticoagulant use,peripheral blood eosinophil count had good predictive ability(AUC> 0.7);besides,The analysis also shows that except that injury history has no predictive ability,All the other related factors have some predictive power in terms of postoperative recurrence,However,there are more obvious mutual influence and collinearity problems between various factors,Therefore,it is considered that only independent risk factors among all the factors have certain clinical significance for predicting postoperative recurrence.Conclusion:(1)two groups of patients in age,hypertension,diabetes,cerebral infarction,have a clear history of trauma,preoperative taking anticoagulant drugs,postoperative atorvastatin,hematoma separation,intraoperative hematoma clearance,hematoma density typing,midline shift degree,lymphocytes in peripheral blood,neutrophils,eosinophil count,serum albumin has obvious differences.(2)Different classification of hypertension,diabetes,cerebral infarction,definite history of trauma,preoperative anticoagulant,hematoma separation,intraoperative hematoma clearance,and degree of midline shift play a certain role in postoperative recurrence of CSDH patients;high content of atorvastatin and serum albumin suppresses the postoperative recurrence;lymphocyte,neutrotrophil and eosinophil counts in patients with postoperative recurrence.(3)preoperative administration of anticoagulant drugs,presence of hematoma,confounding density of hematoma,peripheral blood eosinophil count and intraoperative hematoma clearance were independent risk factors for postoperative recurrence.(4)The predictive ability of preoperative anticoagulant drugs,septation of hematoma,and peripheral blood eosinophil count is better than other factors.