80. Early mobilization after incidental durotomy: a systematic review

Abstract

<h3>BACKGROUND CONTEXT</h3> The conventional management of incidental dural tears involving a prolonged period of flat bed rest is highly debatable. There is no consensus regarding the need or ideal duration of postoperative bed rest following these dural tears. <h3>PURPOSE</h3> To systematically evaluate the relevant literature regarding the outcomes of mobilization within 24 hours after incidental durotomy with respect to the length of hospital stay, minor complications and reoperation rates. The data were compared to that of later mobilization (after 24 hours). <h3>STUDY DESIGN/SETTING</h3> A systematic review and meta-analysis. <h3>PATIENT SAMPLE</h3> Overall, 533 patients (mean age 61.1 years) had an incidental dural tear and were mobilized within 24 hours. Additionally, 203 patients of mean age 72.8 years (6 studies) were mobilized after 24 hours (24 – 144 hours). <h3>OUTCOME MEASURES</h3> We aimed to measure hospital stay, minor complications and reoperation rates in early mobilized patients after incidental durotomies. <h3>METHODS</h3> A systematic review of the English language literature dating to December 2021, was undertaken using search criteria ([dural tear or durotomy] and [mobilization or bed rest]) and the PRISMA guidelines. Isolated case reports were excluded. <h3>RESULTS</h3> The average hospital stay for early mobilized patients was 3.65 days. Twenty-two out of 533 (4.1%) patients (11 studies) had a major complication that required reoperation while the rate of minor complications was 27 out of 230 (11.7%) (9 studies). Comparing early to late mobilization, there was a significant reduction in the risk of minor complications due to early mobilization (13/102 [12.7%] vs 33/106 [31.1%] RR: 0.47, 95CI: 0.27, 0.80), but no significant difference in major complications (3 studies) (12/106 [11.3%] vs 11/134 [8.2%] RR: 1.55, 95CI: 0.72, 3.35). <h3>CONCLUSIONS</h3> This systematic review compared early and late mobilisers after incidental durotomies, finding that minor complications including headaches, nausea, tinnitus and vomiting were, in fact, significantly reduced with early mobilization. Indeed, early mobilization within 24 hours after incidental dural tears appears to be safe and did not need lead to a significantly higher re-operation rate compared to more prolonged bed rest. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.