Effect of the postoperative Trendelenburg position on chronic subdural hematoma recurrence: a pilot clinical trial

OBJECTIVE The aim of the study was to evaluate the effect of the postoperative Trendelenburg position on the recurrence of chronic subdural hematoma (CSH) in patients after surgical drainage. METHODS A pilot randomized, controlled clinical trial was conducted in 3 hospitals in Colombia. Patients with CSH were enrolled and assigned to a Trendelenburg position (30° leg elevation and 10° head tilt; intervention group) or to a flat position (control group) for 24 hours postoperatively. CSH recurrence was measured at 3 months, along with functional outcome (modified Rankin Scale [mRS] score), adverse events, and patient comfort. RESULTS Twenty-three patients were assigned to the Trendelenburg group and 23 to the control group. Two patients from the intervention group were assigned to the control group because of minor complications. Recurrence of CSH was 4.8% in the intervention group and 28.6% in the control group (p = 0.038). A favorable outcome (mRS score 0–2) was achieved in 95.2% of the intervention group versus 66.7% in the control group (p = 0.025). Patient comfort was equal in both groups (47.6% vs 48%, p = 0.979). CONCLUSIONS In patients with CSH who require surgery, the postoperative Trendelenburg position is associated with lower recurrence and improved functional outcome at 3 months. Further studies are required to obtain more clinical evidence.