World neurosurgery · 2025
Early Mobilization in Chronic Subdural Hematoma: A Systematic Review and Meta-Analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод в очереди
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AlDallal Usama, Veremu Munashe, O'Leary Sean, Cook William H, Chedid Youssef, Henney Alex, Ashraf Mohammad, Quist David, Omar Vian, Mazzoleni Adele, Brannigan Jamie F M, Watson Matthew, Lee Keng Siang, Mantle Orla, Gamage Githmi Palahepitiya, Touzet Alvaro Yanez, Adegboyega Gideon, Goacher Edward, Mowforth Oliver D, Gillespie Conor S, Stubbs Daniel J, Davies Benjamin M, ICENI Clinical Practice Guidelines for Chronic Subdural Haematoma Consortia
Аннотация
BACKGROUND: There is variation in timing of postoperative mobilization in patients with chronic subdural hematoma (cSDH). Some studies suggest that early postoperative mobilization may reduce complications, without increase in recurrence. This review aims to evaluate whether timing of postoperative mobilization impacts such outcomes.
METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses-adherent systematic review and meta-analysis. Full-text articles comparing early mobilization (EM) 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 and Embase databases (search date April 30, 2022, updated December 1, 2023). The primary outcome was complications (in-hospital, infection, and thromboembolic disease) and recurrence. Risk of bias was assessed using the Newcastle Ottowa Scale and Cochrane Risk of Bias 2 tool.
RESULTS: Six studies, with a total of 630 patients, met the final inclusion criteria. Most studies (4/6) were randomized control trials. Median follow-up time was 3 months after surgery (interquartile range: 0.5-5.5). Complications were lower in EM group (15.9% vs. 27.2%, odds ratio [OR]: 0.43, 95% confidence interval [CI]: 0.28-0.70, I2 = 0%). There was no significant difference in recurrence rates between 2 groups (11.6% vs. 6.9%, OR: 1.50, 95% CI: 0.68-3.31, I2 = 0%). Head position did not affect complications (3 studies, OR: 0.71, 95% CI: 0.02-29.62), or recurrence rates (2 studies, OR: 1.35, 95% CI: 0.63-2.66). Mortality was intended as a secondary outcome but could not be analyzed due to insufficient data. Almost all studies scored as high risk of bias on assessment.
CONCLUSIONS: EM decreases complications after cSDH, but is not associated with higher risk of recurrence. Additional prospective studies are required to further characterize this potential association, with greater sample size and clear outcome definitions.
METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses-adherent systematic review and meta-analysis. Full-text articles comparing early mobilization (EM) 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 and Embase databases (search date April 30, 2022, updated December 1, 2023). The primary outcome was complications (in-hospital, infection, and thromboembolic disease) and recurrence. Risk of bias was assessed using the Newcastle Ottowa Scale and Cochrane Risk of Bias 2 tool.
RESULTS: Six studies, with a total of 630 patients, met the final inclusion criteria. Most studies (4/6) were randomized control trials. Median follow-up time was 3 months after surgery (interquartile range: 0.5-5.5). Complications were lower in EM group (15.9% vs. 27.2%, odds ratio [OR]: 0.43, 95% confidence interval [CI]: 0.28-0.70, I2 = 0%). There was no significant difference in recurrence rates between 2 groups (11.6% vs. 6.9%, OR: 1.50, 95% CI: 0.68-3.31, I2 = 0%). Head position did not affect complications (3 studies, OR: 0.71, 95% CI: 0.02-29.62), or recurrence rates (2 studies, OR: 1.35, 95% CI: 0.63-2.66). Mortality was intended as a secondary outcome but could not be analyzed due to insufficient data. Almost all studies scored as high risk of bias on assessment.
CONCLUSIONS: EM decreases complications after cSDH, but is not associated with higher risk of recurrence. Additional prospective studies are required to further characterize this potential association, with greater sample size and clear outcome definitions.