Early Mobilization in Chronic Subdural Hematoma: A Systematic Review and Meta-analysis

Introduction: Given the variation in postoperative mobilization timing in chronic subdural hematoma (cSDH) patients, there is some controversy regarding the impact of its timing, with some previous studies suggesting that early postoperative mobilization may reduce complications such as recurrence. This systematic review aims to evaluate whether postoperative mobilization impacts the outcome in cSDH patients and to analyze the quality of evidence (QOE) of the included studies.

Methods: PRISMA-Adherent Systematic Review and Meta-Analysis. Full-text articles comparing early mobilization and elevated head position against conventional methods were included. Search string developed to identify studies reporting on surgical treatment of cSDH was applied to MEDLINE, Cochrane Library, EMBASE, and CINAHL databases (search date 30th April 2022). The primary outcome of this study was complications and recurrence. Risk of bias was assessed using the NOS scale and GRADE framework.

Results: Six studies, with a total of 630 patients, met the final inclusion criteria. Most studies (5/6) included were randomized control trials. Median follow-up time was 3 months after surgery. Complications were lower in the EM group (8.3% vs 18.3%, OR 0.50, 95% CI 0.34-0.76, I2 = 0%). There was no significant difference in recurrence rates between the two groups (11.6% vs 6.9%, OR 1.57, 95% CI 0.88-2.80, I2=0%).

Conclusion : Early mobilization and head elevation decrease complications after cSDH, but are not associated with a higher risk of recurrence. Additional prospective studies are required to further characterize this potential association.