• Gabriel Alcalá-Cerra, Luis Rafael Moscote-Salazar, Ángel Paternina-Caicedo, Juan José Gutiérrez-Paternina, Lucía M Niño-Hernández, and Rubén Sabogal-Barrios.
• Grupo de Investigación en Ciencias Neurológicas y Neurociencias (CISNEURO), Cartagena de Indias, Colombia; Departamento de Neurocirugía, Universidad de Cartagena, Cartagena de Indias, Colombia. Electronic address: cisneuro.investigacion@gmail.com.
• Neurocirugia. 2014 May 1; 25 (3): 99-107.

IntroductionSeveral studies have suggested the possible influence of postoperative bed header position on the risk of symptomatic recurrences and medical complications in patients who have been intervened due chronic subdural haematomas. Nevertheless, this hypothesis has not been assessed by a meta-analysis.MethodsAll randomised controlled trials analysing symptomatic recurrence rates in patients who underwent burr-hole drainage of chronic subdural haematomas, describing postoperative bed header positioning, were included. The primary outcome was risk of recurrence and the secondary outcome were the risks of reoperation and medical complications. Results were presented as pooled relative risks, with 95% confidence intervals.ResultsA total of 4 controlled studies were included. Pooled relative risks were: symptomatic recurrences 0.51 ([95% CI: 0.22-1.16]; P=.11), reoperations, 1.07 ([95% CI: 0.42-2.69]; P=.89) and medical complications, 1.15 ([95% CI: 0.7-1.91]; P=.58). No statistically significant heterogeneity was found in any of the analyses.ConclusionThere were no differences regarding frequency of symptomatic recurrences, reoperations or medical complications in patients who were maintained in a flat position compared with those whose bed header was elevated during the postoperative course. Despite there being consistency between the results, there is a potential risk of bias; thus proscribing definitive recommendations until studies with higher methodological quality are available.Copyright © 2013 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

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