Impact of an early mobilization protocol on the reduction of medical complications after surgery for chronic subdural hematoma: the GET-UP Trial

Autor: Sérgio Sousa, Vasco Pinto, Filipe Vaz da Silva, Tiago Ribeiro da Costa, Armindo Fernandes, Rodrigo Batata, Carolina Noronha, João Monteiro Silva, Sónia Ferreira, Salomé Sobral, Célia Alves, Rui Rangel, Alfredo Calheiros, Jorge Antunes, Miguel Fidalgo, Ana Grande, Gonçalo Figueiredo, Luís Rocha, Eduardo Cunha, Miguel Ferreira, Sérgio Moreira, Ana Machado, Márcia Tizziani, Carla Silva, Elsa Silva, Joaquim Reis, Mário Gomes, Célia Pinheiro, Dora Simões, Isabel Ribeiro, Pedro Amorim, Sara Barbeiro, Vanessa Teixeira, Sílvia Henriques, Maria Laura Gonçalves, Graça Magalhães, Ana Lacerda, Ana Paula Couto, Ana Paula Silva, Ana Ribeiro, Ana Rita Poças, Anabela Neves, Andreia Portela, Andreia Preto, Andreia Queirós, António Caeiro, Ariana Rocha, Bruna Mateus, Cristiana Pereira, Daniel Cunha, Daniela Sousa, Elsa Oliveira, Ema Paula Ribeiro, Hélder Rocha, Inês Barbosa, Inês Carvalho, Inês Cunha, Inês Lima, Inês Pires, Inês Santos, Isabel Martins, Isabel Ramos, Joana Silva, Jorge Castanheira, José Ferreira, Júlia Leitão, Juliana Silva, Leonela Margarita Torre, Lucília Alves, Manuel Sá Pinto, Margarida Lopes, Maria do Céu Amaral, Maria João Rocha Melo, Maria Monteiro, Maria Teresa Lisboa, Mariana Silva, Marília Saffarizadeh, Marisa Moreira, Marlene Luz, Noémia Costa, Patrícia Capas, Rita Quintela, Rosa Silva, Rui Neto, Rui Santos, Sílvia Silva, Simão Pinto, Sofia Queirós, Tiago Oliveira
Rok vydání: 2023
Předmět:
Zdroj: Journal of Neurosurgery. :1-10
ISSN: 1933-0693
0022-3085
DOI: 10.3171/2023.2.jns222262
Popis: OBJECTIVE Timing of mobilization after chronic subdural hematoma (cSDH) surgery is highly heterogeneous among neurosurgical centers. Past studies have suggested that early mobilization may reduce medical complications without increasing recurrence, but evidence remains scarce. The purpose of this study was to compare an early mobilization protocol with a 48-hour bed rest practice, with a focus on the occurrence of medical complications. METHODS The GET-UP Trial is a prospective, randomized, unicentric, open-label study with an intention-to-treat primary analysis designed to evaluate the impact of an early mobilization protocol after burr hole craniostomy for cSDH on the occurrence of medical complications and functional outcomes. A total of 208 patients were recruited and randomly assigned to either an early mobilization group where they began head-of-bed elevation within the first 12 hours after surgery and proceeded to sedestation, orthostatism, and/or walking as rapidly as tolerated, or to a bed rest group where they remained recumbent with a head-of-bed angle inferior to 30° for 48 hours after surgery. The primary outcome was the occurrence of a medical complication (defined as either an infection, seizure, or thrombotic event) after surgery and until clinical discharge. Secondary outcomes included length of stay measured from randomization to clinical discharge, surgical hematoma recurrence at clinical discharge and 1 month after surgery, and Glasgow Outcome Scale–Extended (GOSE) assessment at clinical discharge and 1 month after surgery. RESULTS A total of 104 patients were randomly assigned to each group. No significant baseline clinical differences were observed before randomization. The primary outcome occurred in 36 (34.6%) patients included in the bed rest group and 20 (19.2%) in the early mobilization group (p = 0.012). At 1 month after surgery, a favorable functional outcome (defined as GOSE score ≥ 5) was observed in 75 (72.1%) patients in the bed rest group and 85 (81.7%) in the early mobilization group (p = 0.100). Surgical recurrence occurred in 5 (4.8%) patients in the bed rest group and 8 (7.7%) in the early mobilization group (p = 0.390). CONCLUSIONS The GET-UP Trial is the first randomized clinical trial to assess the impact of mobilization strategies on medical complications after burr hole craniostomy for cSDH. Early mobilization was associated with a reduction in medical complications without a significant effect on surgical recurrence, compared with a 48-hour bed rest protocol.
Databáze: OpenAIRE
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