Early Versus Late Mobilization Following Chronic Subdural Hematoma Surgery: A Systematic Review

BACKGROUND: Chronic subdural hematoma (cSDH) is a prevalent neurosurgical condition, particularly in the elderly. In cases of surgical evacuation, there is conflicting evidence regarding the impact of early versus late mobilization on patient outcomes. METHOD: To understand the current state of the literature, we performed a comprehensive systematic review of studies comparing early and late mobilization protocols in cSDH patients following surgical evacuation. We conducted a supplementary meta-analysis to assess the effects of early versus late mobilization for recurrence and postoperative complication outcomes. RESULTS: Of the 1295 identified articles, 4 studies comprising 622 patients were included. Early mobilization (EM) was typically defined as ambulation ≤ 48 hours post-surgery and late mobilization as bed rest for ≥48 hours or more, though definitions varied between studies. EM did not increase cSDH recurrence in any study. Two studies reported decreased medical complications in the EM group. Two studies suggested a shorter hospital stay with EM, and one study reported significantly better functional recovery on follow-up. A supplementary meta-analysis did not find any significant differences in recurrence or medical complications across studies. CONCLUSION: EM after cSDH surgery may reduce postoperative complications and potentially improve recovery without appearing to affect recurrence rates. However, data interpretation was limited by heterogeneous study designs, definitions of mobilization and outcome measures. Further multicenter trials with consistent protocols and outcome scales are warranted to further establish optimal mobilization strategies.