Role of the postoperative subdural space and midline shift in predicting chronic subdural hematoma recurrence: A single-center study

Background: Chronic subdural hematomas (CSDHs) commonly occur in older adults, and CSDH recurrence after initial surgical treatment is likely. Identifying patients at high risk of CSDH recurrence is crucial to improving care. This study aimed to identify preoperative and postoperative radiographic variables associated with recurrence in cases of bilateral CSDH in a Puerto Rican population. Methods: A single-center population-based retrospective review was performed using data from adult patients who underwent surgical evacuation of new-onset CSDHs. Patient demographics, clinical characteristics, and computed tomographic images were assessed preoperatively and postoperatively. Univariate and multivariate analyses were used to determine predictors of CSDH recurrence. Both unilateral CSDH and bilateral CSDHs were included in the analysis. Results: A total of 428 patients were treated during the study period; 45 (10.5%) had at least 1 recurrence. The median (interquartile range) time to recurrence was 26 (16–56) days. In patients with bilateral CSDHs, postoperative midline shift ( P = 0.01) and the size of the postoperative secondary subdural space ( P = 0.04) are independently associated with recurrence. Conclusion: Postoperative radiographic findings are valuable predictors for identifying patients at high risk of CSDH recurrence after initial surgical evacuation, specifically in cases of bilateral CSDH. Patients identified as having a high risk of CSDH should receive additional treatment and be closely monitored with strict postoperative surveillance.