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

2023; American Association of Neurological Surgeons; Volume: 139; Issue: 3 Linguagem: Inglês

10.3171/2023.2.jns222262

1933-0693

S. G. Sousa, Vasco Pinto, Filipe Vaz da Silva, Tiago Ribeiro da Costa, Armindo Fernandes, Rodrigo Batata, Carolina Noronha, João Silva, Sónia Ferreira, Salomé Sobral Sousa, Célia Alves, Rui Rangel, Alfredo Calheiros, _ _, Jorge M. Antunes, Miguel Fidalgo, Ana Grande, Gonçalo Figueiredo, L.A. Rocha, Eduardo Grala da Cunha, Miguel A. Ferreira, Sérgio Rodrigues Moreira, Ana Lúcia Machado, Márcia Tizziani, Carla Silva, Elsa Silva, Joaquim Reis, Mário Gomes, Célia Pinheiro, Dora Simões‎, Isabel Ribeiro, Pedro Amorim, Sara Barbeiro, Vanessa Teixeira, Sílvia Helena Henriques Camelo, Maria Laura Gonçalves, Graça Maria Alves dos Santos Magalhães, Ana Cristina Rodrigues Lacerda, Ana Paula Couto, Ana Paula Silva, Ana Bela Sarmento‐Ribeiro, Ana Rita Poças, Anabela Neves, Andreia Portela, Andreia Preto, Andreia Queirós, António de Castro Caeiro, Ariana Rocha, Bruna Mateus, Cristiana Pereira, Daniel Ferreira da Cunha, Daniela M. Sousa, Elsa Oliveira, Ema Paula Ribeiro, Hélder R. O. Rocha, Inês A. Barbosa, Inês Carvalho, Inês Cunha, Inês Lima, Inês Falcão‐Pires, Inês Maria Meneses dos Santos, Isabel Pavão Martins, Isabel Ramos, Joana Silva, Jorge Castanheira, J.A.M. Ferreira, Júlia Leitão, Juliana Silva, Leonela Margarita Torre, Lucília Alves, Vasco Pinto, Margarida Chagas 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,

Pituitary Gland Disorders and Treatments

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.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.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).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.