Subdural versus subgaleal drains: Impact on postoperative complications and length of stay following subdural hematoma evacuation

Background: Subdural hematoma (SDH) is a common neurosurgical pathology, typically managed surgically in symptomatic cases. We aimed compare postoperative outcomes between subdural and subgaleal drain placements in SDH patients at single Scottish neurosurgical centre. Methods: Retrospective chart review of all non-acute SDH cases undergoing surgery between October 2022 and August 2024 undertaken. Patients were identified using ICD-10 codes and confirmed via electronic records. Their post-operative course, and the length of stay were compared between the two drain types. Results: Among the 55 SDH cases, 48 (87.3%) were males and 7 (12.7%) females. The mean age was 75 years (range 22-87, SD=10.93). Nine (16.4%) cases were subacute, 15 (27.3%) acute-on-chronic, and 31 (56.4%) were chronic. Forty one patients (74.5%) underwent unilateral burr hole evacuation, 6 (10.9%) had bilateral hematoma evacuation and 7 (12.7%) had mini-craniotomy. Only 1 (1.8%) patient had a standard craniotomy. Among these, 23 (41.8%) had subgaleal and 32 (58.2%) had subdural drains. Mean drain duration was 2 days (range 1-4, SD 0.52). Post-op complications included hematoma recurrence (20%), infections (7.3%), seizures (14.5%), pneumocephalus (73.5%) and scalp swelling (3.6%). One post-op death occurred. The median hospital stay was 7 days, with mean modified Rankin Scale at discharge of 2.5. No statistically significant differences were observed in recurrence (OR=0.76, p=0.75), infections (OR=0.45, p=0.63), pneumocephalus (OR=1.27, p=0.76), seizures (OR=0.17, p=0.12), or length of hospital stay (Z=-1.47, p=0.14) between the two drain types. Conclusion: Subdural and subgaleal drains yielded no significant differences in the rates of recurrence, postoperative infections, and length of hospital stay in this cohort.