Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Oct 10:204:124546.
doi: 10.1016/j.wneu.2025.124546. Online ahead of print.

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

Usama AlDallal  1 , Munashe Veremu  1 , Sean O'Leary  2 , William H Cook  1 , Youssef Chedid  1 , Alex Henney  3 , Mohammad Ashraf  4 , David Quist  1 , Vian Omar  5 , Adele Mazzoleni  6 , Jamie F M Brannigan  1 , Matthew Watson  1 , Keng Siang Lee  7 , Orla Mantle  1 , Githmi Palahepitiya Gamage  8 , Alvaro Yanez Touzet  9 , Gideon Adegboyega  1 , Edward Goacher  10 , Oliver D Mowforth  1 , Conor S Gillespie  1 , Daniel J Stubbs  11 , Benjamin M Davies  12 ; ICENI Clinical Practice Guidelines for Chronic Subdural Haematoma Consortia
Affiliations
Free article
Review

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

Usama AlDallal et al. World Neurosurg. .
Free article

Abstract

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.

Keywords: Chronic subdural hematoma; Mobilization; Neurosurgery.

PubMed Disclaimer

LinkOut - more resources