{
  "abstract": "Background: Early brain re-expansion may indicate recurrence risk after chronic subdural hematoma evacuation. This study examined its association with 90-day symptomatic recurrence and its incremental prognostic value.\n\nMethods: This retrospective study included 286 adults undergoing first-time burr-hole evacuation with closed drainage. Volumes on preoperative computed tomography and postoperative imaging at 22–26 h were used to standardize re-expansion to 24 h. Symptomatic recurrence required clinical deterioration, radiographic progression, and reintervention. Follow-up began at postoperative imaging and ended by postoperative day 90. Cause-specific Cox and Fine–Gray models used joint strata for brain atrophy and antithrombotic use, with additional adjustment for age, bilateral disease, and preoperative volume. Internal validation used 1,000 patient-level bootstrap samples with the stratum structure held fixed.\n\nResults: Symptomatic recurrence occurred in 47 patients (16.4%); eight died before recurrence and 231 remained alive without recurrence. Each 10-percentage-point/24 h increase in re-expansion was associated with a lower cause-specific hazard (adjusted hazard ratio, 0.74; 95% confidence interval, 0.64–0.85) and subdistribution hazard (adjusted subdistribution hazard ratio, 0.74; 95% confidence interval, 0.65–0.85; both P < 0.001). Adding re-expansion increased the within-stratum Harrell concordance index from 0.657 to 0.695 (difference, 0.039; 95% confidence interval, −0.015 to 0.092; P = 0.155). The 90-day area under the receiver operating characteristic curve increased from 0.731 to 0.774 (difference, 0.042; 95% confidence interval, 0.001–0.083; P = 0.043). The full Fine–Gray model had an optimism-corrected Brier score of 0.116 and calibration slope of 0.89.\n\nConclusions: Faster first-day brain re-expansion was associated with lower symptomatic recurrence hazard after accounting for competing death. The internally observed increase in 90-day discrimination requires external validation before clinical application.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Anesthesiology, Affiliated Hospital of Beihua University, Jilin City, Jilin Province, China",
    "Department of Neurology, Affiliated Hospital of Beihua University, Jilin City, Jilin Province, China",
    "Department of Anesthesiology, Huai’an Hospital of Huai’an City (Huai’an Clinical Medical College of Jiangsu University), Huai’an City, Jiangsu Province, China"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Yinxing Sheng"
    },
    {
      "affs": [
        1
      ],
      "name": "Jinfeng Pang"
    },
    {
      "affs": [
        2
      ],
      "name": "Wen Wang"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/d3hh9mf3yskw9.bib",
  "cited_by": 0,
  "doi": "10.3389/fsurg.2026.1949842",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13731228/",
  "id": "d3hh9mf3yskw9",
  "issns": [
    "2296-875X"
  ],
  "landing_url": "https://doi.org/10.3389/fsurg.2026.1949842",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Research"
    ],
    [
      "openalex",
      "2728|Neurosurgical Procedures and Complications"
    ]
  ],
  "openalex": "W7223142003",
  "pdf_url": "https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2026.1949842/pdf",
  "pmcid": "PMC13731228",
  "pmid": "42984565",
  "published": "2026-10-21",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/d3hh9mf3yskw9.ris",
  "sources": [
    {
      "first_seen": "2026-11-08T12:21:27Z",
      "native_id": "PMC13731228",
      "source": "pmc",
      "url": "https://doi.org/10.3389/fsurg.2026.1949842"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2728|Neurosurgical Procedures and Complications",
      "subfield": "neurology"
    }
  ],
  "title": "Brain re-expansion rate on the first postoperative day and risk of symptomatic recurrence after burr-hole drainage for chronic subdural hematoma",
  "title_text": "Brain re-expansion rate on the first postoperative day and risk of symptomatic recurrence after burr-hole drainage for chronic subdural hematoma",
  "type": "peer-reviewed",
  "updated_at": "2026-11-08T12:21:27Z",
  "url": "https://research.draconitic.com/paper/d3hh9mf3yskw9",
  "venue": "Frontiers in Surgery",
  "versions": []
}