Decompressive craniectomy versus craniotomy for acute subdural hematoma: Updated meta-analysis of real-world clinical outcome after RESCUE-ASDH trial

INTRODUCTION The Randomized Evaluation of Surgery with Craniectomy for Patients Undergoing Evacuation of Acute Subdural Hematoma trial found that disability and quality-of-life outcomes were similar between craniotomy and decompressive craniectomy for traumatic acute subdural hematoma (ASDH), contrasting previous literature. This meta-analysis aimed to validate the applicability of RESCUE-ASDH results using real-world data in ASDH patients. METHODS We searched Chocrane, Embase, and MEDLINE for relevant articles reporting clinical outcomes of craniotomy and decompressive craniectomy. Meta-analysis used R software (Ross Ihaka and Robert Gentleman at the University of Auckland, New Zealand) with the restricted maximum likelihood method for random-effects meta-analyses, presenting odds ratios (ORs) and 95% confidence intervals (CIs) with Hartung-Knapp-Sidik-Jonkman adjustment for heterogeneity. RESULTS Besides RESCUE-ASDH, five retrospective studies were included, spanning 2006 to 2016. A total of 961 patients with traumatic ASDH were included in this study (craniotomy, 467; decompressive craniotomy, 494). The pooled analysis of retrospective studies showed no significant difference in poor clinical outcomes between the two groups (OR, 0.59; 95% CI, 0.32–1.10). These findings align with the RESCUE-ASDH trial (OR, 0.84; 95% CI, 0.58–1.23). Mortality rate was significantly higher in patients undergoing craniectomy in pooled result of retrospective studies (OR, 0.59; 95% CI, 0.32–1.10). In RESCUE-ASDH trial, reoperation rate was higher in the craniotomy group, but the pooled result of retrospective did not show significant difference between the craniotomy and craniectomy group. CONCLUSION This real-world evidence confirms the RESCUE-ASDH trial results. Both craniotomy and decompressive craniectomy yielded similar disability and quality-of-life outcomes for traumatic ASDH patients. LEVEL OF EVIDENCE Systematic Review/Meta-Analysis; Level III.