Analysis Of Risk Factors For Postoperative Recurrence Of Chronic Subdural Hematoma And The Preventive Effect Of Atorvastatin

Objective: Chronic subdural hematoma(CSDH)is a common disease in Department of neurosurgery,and it is common in the elderly.The etiology of CSDH are related to traumatic brain injury in most of patients.Its treatment methods include surgery and drugs.Although surgical treatment have achieved a better outcome,there is still a certain recurrence rate after operation.There are many reasons that affect the postoperative recurrence,and there is no definite conclusion.Prevention of postoperative recurrence in CSDH patients has become a key concern of neurosurgeons.In recent years,atorvastatin has achieved relatively good clinical effects in the treatment of CSDH,but its role in preventing postoperative recurrence is still unclear.This study will analyze the risk factors for postoperative recurrence in CSDH patients and explore the preventive effect of atorvastatin.The study is divided into three parts:(1)Analysis of risk factors for postoperative recurrence in CSDH patients;(2)Retrospective analysis of the effect of atorvastatin on preventing postoperative recurrence of CSDH;(3)Prospective study of the effect of atorvastatin on preventing postoperative recurrence of CSDH.Methods:(1)A retrospective analysis of CSDH patients from January 2013 to December 2018 in the Department of Neurosurgery of Subei People’s Hospital,and they underwent YL-1 puncture needle drill cranial irrigation and drainage.Baseline characteristics including sex,age,past medical histories(history of injury,anticoagulation,liver dysfunction,heart diseases,malignant tumors,diabetes,hemodialysis,and chronic alcoholism),computed tomography(CT)or magnetic resonance imaging(MRI)diagnostic indicators(bilateral,mixed density or signal,maximum hematoma width,and brain atrophy),and the recurrence after surgery were recorded.According to the postoperative recurrence,they were divided into recurrence group and non-recurrence group,and the differences in clinical indicators between the two groups were compared.(2)Case collection and clinical indicators statistics are the same as(1).According to whether or not atorvastatin was taken orally for 3 months(20 mg,once a day)after the operation,they were divided into drug group and non-drug group,and differences in recurrence rates were compared between two groups.(3)A prospective study of CSDH patients from January 2019 to September 2020 in the Department of Neurosurgery of Subei People’s Hospital,they underwent YL-1puncture needle drill cranial irrigation and drainage and randomly divided into experimental group and control group.The experimental group took 20 mg of atorvastatin(Lipitor,Ruihui Pharmaceutical Company,20mg/tablet)at the first day after operation,once a day for 3 months,while the control group did not take the drug.The head CT scans were performed at the first day after surgery,the previous day of discharge,the first and third month after surgery,postoperative imaging characters(including brain atrophy,maximum postoperative subdural space and recurrence)and the side effects of atorvastatin(including drug-induced liver damage,rhabdomyolysis,etc.)were recorded.The differences between the two groups of observation indicators were compared.Results:(1)Among 516 patients,the recurrence group had 33 and 483 were in the nonrecurrence group.After univariate analysis,the proportion of antithrombotic therapy in the recurrence group was higher than that in the non-recurrence group(P<0.05),and further Logistic regression analysis showed that the difference between the two groups was still statistically significant,suggesting that whether the patient has antithrombotic therapy is an independent risk factor for postoperative recurrence in CSDH patients.(2)Among 516 patients,the drug group underwent 360 procedures,of which 25 had hematoma recurrence,and the recurrence rate was 7.0%;the non-drug group underwent 250 procedures,of which 14 had hematoma recurrence,and the recurrence rate was 5.6%.Univariate analysis indicated no statistically significant difference in recurrence rates between groups(P>0.05).(3)Among 86 patients enrolled,the experimental group had 44 and 42 were in the control group.There was no significant difference between the two groups of patients about baseline indicators,including sex,age,past medical history,preoperative imaging characteristics,postoperative imaging characteristics(P>0.05).One case recurred after surgery in the experimental group,the recurrence rate was about 2.3%;and one case recurred after surgery in the control group,the recurrence rate was about2.4%.There was no statistical difference in the recurrence rate between the two groups(P>0.05).Conclusions: The postoperative recurrence of chronic subdural hematoma is related to many factors,among which taking antithrombotic drugs before surgery are an independent risk factor for postoperative recurrence.Atorvastatin has no obvious effect on preventing the recurrence of CSDH after YL-1 puncture needle drilling cranial irrigation and drainage.