Statins May Not Reduce Reoperation Rates in Chronic Subdural Hematoma, Regardless of the Use of Antithrombotic Medication

Abstract Various studies have shown a beneficial effect of statins in patients with chronic subdural hematoma (cSDH) who do not require surgery. In surgical cohorts, however, the results of statin treatment in cSDH have been inconsistent, and meta-analyses showed no significant effect. It has been hypothesized that this lack of effect may be due to a higher proportion of patients in the statin group taking antithrombotic medication. Therefore, we designed a study to analyze the impact of statins on surgical cSDH patients who did not receive antithrombotic drugs. We conducted a retrospective chart review of patients who received cSDH evacuation via burr-hole trepanation with the implantation of a subdural drain at our institution from 2012 through 2021. The data were pooled with a previously analyzed cohort to result in a two-center analysis. Patients who received antithrombotic medication were excluded. We separated the patients into a statin group and a control group based on whether they received a statin as part of their home medication and evaluated the rate of reoperations for any reason as the primary outcome parameter, and reoperations for residual hematoma and hematoma recurrence, respectively, as secondary outcome parameters. We identified 614 patients in the total cohort, of whom 297 did not take antithrombotic medication. The mean age of these patients was 71.75 ± 13.27 years, and 195 were male (65.66%). A total of 42 patients took statins (14.14%). A reoperation was necessary in 5 patients in the statin group (11.90%) and 35 patients in the control group (13.73%), p = 0.749. Residual hematoma after the initial surgery was ascertained in 2 patients in the statin group (4.76%) and 17 in the control group (6.67%), p = 0.640, whereas 3 patients in the statin group (7.14%) and 18 patients in the control group (7.06%) experienced hematoma recurrence, p = 0.984. Logistic regression analysis revealed no significant associations with reoperation. We found no evidence of a beneficial effect of statins in patients undergoing surgery for cSDH, regardless of the use of antithrombotic medication.