Impact of early enteral nutrition combined with bedside rehabilitation on functional outcomes and length of stay in patients with severe subarachnoid hemorrhage: a retrospective cohort study

Objective Early enteral nutrition (EEN) and early rehabilitation have individually demonstrated benefits in neurocritical care. However, the synergistic effects of combining these interventions in severe subarachnoid hemorrhage (SAH) remain unexplored. This study aimed to evaluate the impact of a combined early enteral nutrition and bedside rehabilitation protocol on functional outcomes and length of stay in patients with severe SAH. Methods This retrospective cohort study included 102 patients with severe SAH (Hunt–Hess grade III–V) admitted to the neurosurgical intensive care unit (NSICU) between August 2023 and August 2025. Patients were divided into a combined intervention group ( n = 53), receiving EEN within 48 h and comprehensive bedside rehabilitation within 72 h, and a standard care group ( n = 49). The primary outcome was favorable functional status modified Rankin Scale (mRS) 0–2 at 6 months. Secondary outcomes included mRS at discharge and 90 days, length of stay, complications, and mortality. Results Favorable outcome at 6 months was significantly higher in the combined intervention group compared to standard care (64.2% vs. 30.6%, P = 0.001). Multivariable logistic regression identified combined intervention as an independently associated with favorable outcome (adjusted OR: 3.42, 95% CI: 1.38–8.47, P = 0.008). The intervention group demonstrated significantly shorter ICU stay (13.5 vs. 19.8 days, P = 0.001) and hospital stay (22.4 vs. 26.9 days, P = 0.004). Rates of delayed cerebral ischemia (DCI; 13.2% vs. 42.9%, P = 0.002), cerebral vasospasm (15.1% vs. 36.7%, P = 0.023), and in-hospital mortality (0% vs. 14.3%, P = 0.005) were significantly lower in the intervention group. Conclusions Combined early enteral nutrition and bedside rehabilitation was associated with improved functional outcomes and reduced length of stay in severe SAH patients. This multimodal support further investigation of this multimodal approach in prospective trials.