Association between nonsteroidal anti-inflammatory drugs and lower incidence of surgical treatment of chronic subdural hematoma: A population-based study

Abstract

Background: Chronic subdural hematoma (CSDH) is a common neurosurgical disease and is considered an inflammatory angiogenic entity. An association between nonsteroidal anti-inflammatory drugs (NSAIDs) and surgical CSDH in patients following minor head injury without intracranial bleeding has not been reported. Therefore, we used a national population-based database to investigate the association between the use of NSAIDs and the incidence of surgical CSDH.To investigate the association between nonsteroidal anti-inflammatory drugs and the incidence of surgical chronic subdural hematoma. Materials and Methods: We extracted analytical data from the Longitudinal Health Insurance Database (2010), a subset of the National Health Insurance Research Database. Patients aged younger than 50 years, who had undergone neurosurgical procedures or who had a head injury with intracranial bleeding, were excluded from the study. Results: Of 67,296 patients with minor head injury without intracranial bleeding, 482 (0.72%) developed surgical CSDH. Patients who received NSAIDs were more likely to have comorbidities, including ischemic heart disease, stroke, diabetes mellitus, hypertension, hyperlipidemia, renal diseases, arrhythmia, heart failure, chronic liver disease, and valvular heart disease (P < 0.001). Surgical CSDH was more likely to develop in male patients who did not receive NSAIDs (adjusted odds ratio [OR] = 1.34, 95% confidence interval [CI] = 1.05-1.72, P < 0.05) and those aged >65 years (adjusted OR = 1.5, 95% CI = 1.15-1.92, P < 0.01). The adjusted OR of surgical CSDH in patients who did not receive NSAIDs was 1.37 (95% CI = 1.09-1.71, P < 0.01). Conclusion: Surgical CSDH may be more likely to develop in patients aged >65 years, male patients, and patients who did not receive NSAIDs. NSAID use may be associated with a low incidence of surgical CSDH in patients following minor head injury without intracranial bleeding.