gms | German Medical Science

Objective: Recent studies suggest a beneficial effect of atorvastatin in avoiding surgery in patients with chronic subdural hematoma (cSDH). The role of statins on patients who underwent surgery for cSDH is controversial. A prospective study, which had found a favorable effect, had to be retracted due to methodological flaws. Other studies focused on conservative treatment. We evaluated the effects of statins in a large cohort of patients operated on for cSDH.

Methods: All patients who were operated on for cSDH for the first time between January 2012 and June 2016 at our institution were included in a retrospective study. Patients with cSDH attributed to a preceding craniotomy, low cerebrospinal fluid syndrome, brain malformations or those who died within three months of the initial surgery for unrelated causes were excluded. We evaluated the rate of revision surgery overall, residual hematoma as well as recurrence necessitating revision surgery, acute postoperative hemorrhage, newly developed postoperative epilepsy, wound healing disturbance, and infection. One-sided Fisher exact test was used for comparisons.

Results: We identified 283 consecutive patients with a mean age of 74.6 years (range 25-97 years), 186 (66%) were male. 54 patients (19%) required revision surgery; 24 (8.5%) due to recurrence, 22 (7.8%) due to residual hematoma, and 10 (3.5%) due to acute postoperative hemorrhage. One wound healing disturbance (0.35%) without surgical consequence and one infection occurred. 75 patients (26.5%) received statin therapy with simvastatin being the most frequently used drug and fluvastatin as well as atorvastatin being administered in fewer patients. The rate of male patients in the statin vs. no-statin group was 77% vs. 61% (p = 0.009), the mean age was 76.0 vs. 74.1 years. No difference was found for overall revision surgery (19% vs. 19%, p = 0.6), recurrence (8.0% vs. 8.7%, p = 0.65), residual hematoma (6.7% vs. 8.2%, p = 0.45), acute hemorrhage (4.0% vs. 3.4%, p = 0.52), and postoperative epilepsy (1.3% vs. 2.9%, p = 0.41). Male sex as a confounding factor which might worsen the outcome in the statin group was excluded as female patients had a numerically higher rate of revision surgery (23% vs. 17%, p = 0.17) and residual hematoma (11% vs. 5.9%, p = 0.09).

Conclusion: Our results do not confirm a beneficial role of statins in patients being operated on for cSDH. Different effects of atorvastatin and other statins may be hypothesized.