Posicionamiento postoperatorio de la cabecera tras drenaje de hematomas subdurales crónicos por trepanación: Revisión sistemática y metaanálisis de estudios controlados aleatorizados |
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| Institution: | 1. Grupo de Investigación en Ciencias Neurológicas y Neurociencias (CISNEURO), Cartagena de Indias, Colombia;2. Departamento de Neurocirugía, Universidad de Cartagena, Cartagena de Indias, Colombia;1. Facultad de Medicina, Universidad San Sebastián, Concepción, Chile;2. Division of Internal Medicine, Complejo Asistencial Dr Victor Rios Ruiz, Los Angeles, 4450227, Chile;3. Division of Pulmonary, Critical Care, and Sleep Medicine, University of Florida, Gainesville, FL, USA;4. Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA;5. Divisions of Thoracic Surgery and Interventional Pulmonary, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA;6. Unidad de neumologia intervencional, Clinica Alemana-Universidad del Desarrollo, Santiago, Chile;1. Faculty of Medicine Aleppo University, Aleppo 22743, Syria;2. Faculty of Medicine of Algiers, University of Algiers, Algeria;3. Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan;4. Faculty of Pharmacy, Mansoura University, Mansoura, Egypt;5. Department of Psychiatry and Psychotherapy III, University of Ulm, Ulm, Germany;6. Department of Psychiatry, Jawahar Lal Nehru Memorial Hospital, Srinagar, Kashmir, India;1. Department of Neurosurgery, Salmaniya Medical Complex, Manama, Bahrain;2. Department of Public Health, Independent University−Bangladesh, Dhaka, Bangladesh;3. Department of Neurosurgery, Holy Family Red Crescent Medical College, Dhaka, Bangladesh;1. Department of Neurosurgery, Hospital Universitario Río Hortega, Valladolid, Spain;2. Department of Pathology, Hospital Universitario Río Hortega, Valladolid, Spain |
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| Abstract: | IntroductionSeveral studies have suggested the possible influence of postoperative bed header position on the risk of symptomatic recurrences and medical complications in patients who have been intervened due chronic subdural haematomas. Nevertheless, this hypothesis has not been assessed by a meta-analysis.MethodsAll randomised controlled trials analysing symptomatic recurrence rates in patients who underwent burr-hole drainage of chronic subdural haematomas, describing postoperative bed header positioning, were included.The primary outcome was risk of recurrence and the secondary outcome were the risks of reoperation and medical complications. Results were presented as pooled relative risks, with 95% confidence intervals.ResultsA total of 4 controlled studies were included. Pooled relative risks were: symptomatic recurrences 0.51 (95% CI: 0.22-1.16]; P=.11), reoperations, 1.07 (95% CI: 0.42-2.69]; P=.89) and medical complications, 1.15 (95% CI: 0.7-1.91]; P=.58). No statistically significant heterogeneity was found in any of the analyses.ConclusionThere were no differences regarding frequency of symptomatic recurrences, reoperations or medical complications in patients who were maintained in a flat position compared with those whose bed header was elevated during the postoperative course. Despite there being consistency between the results, there is a potential risk of bias; thus proscribing definitive recommendations until studies with higher methodological quality are available. |
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| Keywords: | Burr-hole Chronic subdural haematoma Posture Recurrence |
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