Abstract Details

Hydrocephalus is a common complication following aSAH and is usually treated with EVD. However, there is no consensus on EVD weaning process and duration of cerebrospinal fluid (CSF) drainage.

To determine the association of external ventricular drain (EVD) duration and outcomes in patients with aneurysmal subarachnoid hemorrhage (aSAH).

We performed a retrospective cohort study of consecutive patients with aSAH who were admitted to an academic referral center between 2016 and 2021. We included survivors. Binary logistic regression was used to test the association of EVD duration and worse outcome (3-month modified Rankin scale 4-6) and requirement for ventriculoperitoneal shunt (VPS) placement. Multiple linear regression analysis was used to test the association of EVD duration and hospital length of stay.

Of 316 patients with aSAH, 253 patients received EVD on admission for symptomatic hydrocephalus and 204 survivors were included. (mean age 57.9 years [SD 13.8], 62% female, 71% white). VPS was placed in 15% (30/204) prior to hospital discharge. Duration of EVD was longer in patients with worse functional outcome (median 18 days [IQR 13.5-23] vs 12 days [IQR 8-19); p=0.006). Longer EVD duration was associated with higher VPS requirement (odds ratio 1.17 per day, 95% CI 1.09-1.26; p<0.001) after adjustment for age, aneurysm related factors, Hunt and Hess grades, modified Fisher scales and delayed cerebral ischemia. EVD related complications such as infections (2%) and tract hemorrhage (9%) were non-significantly higher in patients with longer EVD duration. (p=0.07) Longer EVD duration was associated with longer hospital length of stay (beta=0.88, 95% CI 0.73-1.04; p<0.001) independent of aSAH complications.

Longer EVD duration can be associated with worse outcomes and higher need for VPS placement and longer hospital length of stay. Further studies are needed to justify early VPS placement in selected patients.