Predictors of Recurrence After Surgical Evacuation of Chronic Subdural Hematoma: A Single-Center Retrospective Study of 250 Patients With Development of a Simple Clinical Score

Background: Chronic subdural hematoma (CSDH) is a common neurosurgical condition with a high recurrence rate. Identifying reliable predictors of recurrence is essential to improve postoperative management. However, data from low-resource settings remain limited, and few studies provide clinically applicable predictive tools. Objective: This study aimed to identify independent predictors of recurrence after surgical evacuation of CSDH and to develop a simple, clinically applicable predictive score. Methods: We conducted a retrospective, single-center study including 250 patients who underwent surgery for CSDH at Centre Hospitalier Universitaire Hassan II, Fes. Clinical, radiological, and surgical variables were analyzed. Univariate and multivariate analyses were performed to identify independent predictors of recurrence. A predictive score was developed based on significant variables. Results: The recurrence rate was 20.4%. Multivariate analysis identified anticoagulant therapy, presence of septations, and postoperative pneumocephalus as independent predictors of recurrence. A simple predictive score ranging from 0 to 3 was developed. Recurrence rates increased progressively with higher scores. Conclusion: This study confirms key predictors of CSDH recurrence and proposes a simple, clinically applicable scoring system to stratify patients according to recurrence risk. This tool may help guide postoperative monitoring and improve clinical decision-making. Further validation in multicenter studies is required.