Body temperature irrigation for chronic subdural hematoma should be ‘standard of care’

Irrigation at body temperature was superior to room temperature in the evacuation of chronic subdural hematoma, resulting in fewer recurrences and optimized patient outcomes, researchers reported in JAMA Neurology.

“In theory, irrigation fluid temperature may influence recurrence rates after [chronic subdural hematoma (cSDH)] surgery,” Andreas Bartley, MD, of the Institute of Neuroscience and Physiology at the University of Gothenburg in Sweden, and colleagues wrote. “The increased solubility with irrigation fluid at body temperature compared with room temperature may facilitate cSDH clearance. There may also be negative effects on coagulation when using fluid at room temperature.”

They added, “Despite these theoretical benefits of irrigation at body temperature, it is still common to use irrigation fluid at room temperature.”

Bartley and colleagues assessed the effect of irrigation fluid temperature on recurrence of cSDH by conducting a multicenter, randomized clinical trial of 541 adults (mean age, 75.8 years; 73% men) at three neurosurgical departments in Sweden. Study participants were randomly assigned 1:1 to undergo the cSDH evacuation procedure with irrigation fluid at room temperature (n = 277) or body temperature (n =264). Patients were followed up within 6 months after surgery.

According to results, 14% of patients in the room temperature group required reoperation compared with 6% in the body temperature group (OR = 2.56; 95% CI, 1.38-4.66). The authors reported no significant differences in mortality, quality of life or complication frequency between groups.

“This is a simple, safe and readily available technique to optimize outcome in patients with cSDH,” Bartley and colleagues wrote. “When irrigation is used in cSDH surgery, irrigation fluid at body temperature should be considered standard of care.”