Impact of a Rapid Weaning Protocol on the Incidence of External Ventricular Drain–Related Infections in Patients With Aneurysmal Subarachnoid Hemorrhage: A Retrospective Before–After Comparative Study

BACKGROUND AND OBJECTIVES: External ventricular drainage (EVD) is commonly used in aneurysmal subarachnoid hemorrhage (aSAH) with hydrocephalus but carries a risk of infection (EVDI). Optimal weaning strategies remain uncertain. This study aimed to compare a rapid EVD weaning protocol (RW) with gradual weaning (GW) regarding EVD-related infections, drainage duration, length of hospital stay, and 3-month functional outcome in patients with aSAH. METHODS: We performed a single-center, retrospective, before-and-after study, including adult patients with aSAH requiring EVD. GW (2021-2022) was compared with RW (2023-2025). The primary outcome was EVDI incidence. Secondary outcomes included drainage duration, length of stay, and 3-month modified Rankin Scale (mRS). RESULTS: Among 117 patients, EVDI occurred in 11% of RW vs 34% of GW patients (P = .005). RW patients had reduced median drainage duration (14 [11-19] vs 24 [20-37] days, P < .001), length of stay (27 [24-32] vs 33 [26-48] days, P = .012), and lower 3-month mRS (1 [0-2] vs 2 [1-3], P = .028). After adjustment for confounders, multivariate analysis demonstrated a 74% reduction in the odds of EVDI (odds ratio 0.26, 95% CI, 0.08-0.74, P = .017) and lower 3-month mRS values (β = -0.59, 95% CI, -1.2 to -0.02; P = .045) with the RW protocol. CONCLUSION: Rapid EVD weaning was associated with lower infection rates, shorter drainage duration, and improved functional outcomes. Despite the retrospective design and potential selection bias, RW appears to be a beneficial strategy associated with lower EVDI. Further prospective studies are needed to standardize protocols and confirm these findings.