Impact of an early mobilization protocol on the reduction of medical complications after surgery for chronic subdural hematoma: the GET-UP Trial
Authors: Sousa Sérgio , Pinto Vasco , Vaz da Silva Filipe , Ribeiro da Costa Tiago , Fernandes Armindo , Batata Rodrigo , Noronha Carolina , Monteiro Silva João , Ferreira Sónia , Sobral Salomé , Alves Célia , Rangel Rui , Calheiros Alfredo , _ _ , Antunes Jorge , Fidalgo Miguel , Grande Ana , Figueiredo Gonçalo , Rocha Luís , Cunha Eduardo , Ferreira Miguel , Moreira Sérgio , Machado Ana , Tizziani Márcia , Silva Carla , Silva Elsa , Reis Joaquim , Gomes Mário , Pinheiro Célia , Simões Dora , Ribeiro Isabel , Amorim Pedro , Barbeiro Sara , Teixeira Vanessa , Henriques Sílvia , Laura Gonçalves Maria , Magalhães Graça , Lacerda Ana , Couto Ana Paula , Silva Ana Paula , Ribeiro Ana , Poças Ana Rita , Neves Anabela , Portela Andreia , Preto Andreia , Queirós Andreia , Caeiro António , Rocha Ariana , Mateus Bruna , Pereira Cristiana , Cunha Daniel , Sousa Daniela , Oliveira Elsa , Ribeiro Ema Paula , Rocha Hélder , Barbosa Inês , Carvalho Inês , Cunha Inês , Lima Inês , Pires Inês , Santos Inês , Martins Isabel , Ramos Isabel , Silva Joana , Castanheira Jorge , Ferreira José , Leitão Júlia , Silva Juliana , Torre Leonela Margarita , Alves Lucília , Pinto Manuel Sá , Lopes Margarida , Amaral Maria do Céu , Rocha Melo Maria João , Monteiro Maria , Lisboa Maria Teresa , Silva Mariana , Saffarizadeh Marília , Moreira Marisa , Luz Marlene , Costa Noémia , Capas Patrícia , Quintela Rita , Silva Rosa , Neto Rui , Santos Rui , Silva Sílvia , Pinto Simão , Queirós Sofia , Oliveira Tiago 
Published: March 2023

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.