Preventive Effect of a Multidisciplinary Bundle Rehabilitation Strategy Centered on Expiratory Resistance Feedback Training on Postoperative Complications in Elderly Patients with Chronic Subdural Hematoma: A Multicenter Retrospective Study.

OBJECTIVE: To investigate the preventive effect of a multidisciplinary bundle rehabilitation strategy centered on expiratory resistance feedback training(MBRS) on postoperative complications in elderly patients with chronic subdural hematoma (CSDH). METHODS: A total of 258 patients aged ≥65 years undergoing surgery for CSDH were retrospectively enrolled from multiple centers. According to the actual postoperative rehabilitation protocol in this nonrandomized retrospective cohort, they were divided into the observation group (MBRS, n=115) and the control group (routine care, n=143). The incidences of postoperative pulmonary infection, hematoma recurrence, and lower extremity deep vein thrombosis (DVT), as well as drainage catheter indwelling time, length of hospital stay, and hospitalization cost were compared between the two groups. Multivariable logistic regression adjusted for key confounders was used to identify independent factors associated with complications. Propensity score matching (PSM) was additionally performed as a sensitivity analysis to control for potential confounding. RESULTS: The incidence of pulmonary infection in the observation group was 5%, significantly lower than 15% in the control group (P=0.009). The incidence of lower extremity DVT was 3%, lower than 9% in the control group (P=0.032). The proportion of drainage catheter indwelling ≤3 days was 86% in the observation group, higher than 64% in the control group (P<0.001). The length of hospital stay and hospitalization cost in the observation group were significantly lower than those in the control group (all P<0.001). Multivariate Logistic regression showed that MBRS was an independent protective factor for postoperative pulmonary infection (OR=0.210, 95% CI: 0.073-0.604, P=0.004) and lower extremity DVT (OR=0.183, 95% CI: 0.039-0.850, P=0.030). There were no significant differences in hematoma recurrence rate or the incidence of other complications between the two groups. CONCLUSION: In this retrospective cohort study, MBRS was associated with lower rates of postoperative pulmonary infection and lower extremity DVT, shorter drainage duration and hospital stay, and reduced costs, without increasing hematoma recurrence. Prospective RCTs are needed to confirm these findings.