Irrigation at body temperature improves outcome linked to chronic subdural hematoma evacuation: JAMA

The findings of an article published in the Journal of American Medical Association suggest that irrigation at body temperature outperformed irrigation at room temperature. This is a straightforward, secure, and easily accessible method to improve outcomes in chronic subdural hematoma (cSDH) patients.

Further research is required to determine the impact of an irrigation fluid's physical characteristic (at body vs. room temperature) on the recurrence rate of chronic subdural hematoma evacuation. The purpose of this study, which was carried out by Andreas Bartley and colleagues, was to determine whether irrigation fluid temperature affects cSDH recurrence.

Between March 16, 2016, and May 30, 2020, a randomized multicenter clinical study was conducted in this situation. A six-month follow-up period was used. In Sweden, three neurosurgical departments participated in the study. All patients who had cSDH evacuation and were older than 18 throughout the trial period were assessed to determine their eligibility. The cSDH evacuation method with irrigation fluid either at room temperature (RT group) or at body temperature (B group) was randomly allocated to the trial participants using 1:1 block randomization (BT group). The main goal was to prevent recurrences that required surgery again within six months. Mortality, health-related quality of life, and complication frequency served as secondary end goals.

The key findings of this study were:

1. 541 patients underwent a full follow-up at 6 months following surgery in accordance with procedure.

2. In comparison to 16 of 264 recurrences in the BT group, 39 of 277 recurrences (14%) in the RT group required reoperation.

3. Mortality, health-related quality of life, or occurrence of complications did not differ significantly.

In conclusion, this was the first randomized clinical experiment to compare the effectiveness of irrigation fluid used in cSDH surgery at various temperatures. The findings of our investigation show that body temperature irrigation is preferable to irrigation at room temperature. Body-tempered irrigation fluid ought to be the norm when irrigation is employed during cSDH surgery, suggested the Authors.

Reference: 

Bartley, A., Bartek, J., Jr, Jakola, A. S., Sundblom, J., Fält, M., Förander, P., Marklund, N., & Tisell, M. (2022). Effect of Irrigation Fluid Temperature on Recurrence in the Evacuation of Chronic Subdural Hematoma. In JAMA Neurology. American Medical Association (AMA). https://doi.org/10.1001/jamaneurol.2022.4133