Brain re-expansion rate on the first postoperative day and risk of symptomatic recurrence after burr-hole drainage for chronic subdural hematoma
- 1Department of Anesthesiology, Affiliated Hospital of Beihua University, Jilin City, Jilin Province, China
- 2Department of Neurology, Affiliated Hospital of Beihua University, Jilin City, Jilin Province, China
- 3Department of Anesthesiology, Huai’an Hospital of Huai’an City (Huai’an Clinical Medical College of Jiangsu University), Huai’an City, Jiangsu Province, China
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.
Methods: 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.
Results: 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.
Conclusions: 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.
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BibTeX
@article{sheng2026brain,
title = {{Brain re-expansion rate on the first postoperative day and risk of symptomatic recurrence after burr-hole drainage for chronic subdural hematoma}},
author = {Yinxing Sheng and Jinfeng Pang and Wen Wang},
journal = {Frontiers in Surgery},
year = {2026},
month = oct,
doi = {10.3389/fsurg.2026.1949842},
url = {https://doi.org/10.3389/fsurg.2026.1949842},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Brain re-expansion rate on the first postoperative day and risk of symptomatic recurrence after burr-hole drainage for chronic subdural hematoma
AU - Yinxing Sheng
AU - Jinfeng Pang
AU - Wen Wang
PY - 2026
DA - 2026/10/21
JO - Frontiers in Surgery
DO - 10.3389/fsurg.2026.1949842
UR - https://doi.org/10.3389/fsurg.2026.1949842
AB - 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. Methods: 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. Results: 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. Conclusions: 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.
SN - 2296-875X
ER -