Chronic kidney disease is an independent risk factor of postoperative seizures after burr hole surgery for chronic subdural hematomas

Abstract

Background: Postoperative seizures are serious neurological complications of chronic subdural hematomas (CSDH). The identification of risk factors of seizures after CSDH is needed to determine which patients require antiepileptic prophylaxis. Methods: We retrospectively collected data on patients diagnosed with CSDH from 2015 to 2018. Postoperative seizures are defined as those occurring within 30 days after surgery. Non-hemorrhagic subdural effusion and acute subdural hemorrhage after craniotomy were precluded in the study. We collected data from 221 patients who had burr hole surgery. We retrospectively recorded patient characteristics, hematoma characteristics, symptoms at admission, comorbid conditions, and other related parameters to evaluate the impact of these parameters on postoperative seizures. Results: Postoperative seizures occurred in 16 patients (7.24%). The univariate analysis showed that previous chronic kidney disease (31.25% vs. 5.37%, p= 0.001), age (60.44 vs. 66.54 y, p = 0.029), low Glasgow Coma Score (GCS) at admission (13.69 vs. 14.46, p = 0.015), and preoperative midline shift (9.79 vs. 8.57 mm, p = 0.021) were significantly correlated with postoperative seizures. The multivariate analysis revealed that previous chronic kidney disease (odds ratio [OR] = 27.103; 95% confidence interval [CI] = 4.887-150.296; p < 0.001), younger age (OR = 0.921; 95% CI = 0.866-0.979; p = 0.009) and preoperative midline shift (OR = 1.782; 95% CI = 1.175-2.702; p = 0.007) were independent risk factors of seizures. However, there was no significant difference in GCS at admission. Conclusions: The independent predictors of postoperative seizures in patients with CSDH were preoperative midline shift, chronic kidney disease, and younger age. For younger patients with chronic kidney disease and preoperative midline displacement, we recommend antiepileptic preventive measures during the perioperative period.