Safety and efficacy of a novel neurosurgical enhanced recovery after surgery protocol for elective craniotomy: a prospective randomized controlled trial

Abstract

OBJECTIVEAlthough enhanced recovery after surgery (ERAS) programs have gained acceptance in various surgical specialties, no established neurosurgical ERAS protocol for patients undergoing elective craniotomy has been reported in the literature. Here, the authors describe the design, implementation, safety, and efficacy of a novel neurosurgical ERAS protocol for elective craniotomy in a tertiary care medical center located in China.METHODSA multidisciplinary neurosurgical ERAS protocol for elective craniotomy was developed based on the best available evidence. A total of 140 patients undergoing elective craniotomy between October 2016 and May 2017 were enrolled in a randomized clinical trial comparing this novel protocol to conventional neurosurgical perioperative management. The primary endpoint of this study was the postoperative hospital length of stay (LOS). Postoperative morbidity, perioperative complications, postoperative pain scores, postoperative nausea and vomiting, duration of urinary catheterization, time to first solid meal, and patient satisfaction were secondary endpoints.RESULTSThe median postoperative hospital LOS (4 days) was significantly shorter with the incorporation of the ERAS protocol than that with conventional perioperative management (7 days, p < 0.0001). No 30-day readmission or reoperation occurred in either group. More patients in the ERAS group reported mild pain (visual analog scale score 1–3) on postoperative day 1 than those in the control group (79% vs. 33%, OR 7.49, 95% CI 3.51–15.99, p < 0.0001). Similarly, more patients in the ERAS group had a shortened duration of pain (1–2 days; 53% vs. 17%, OR 0.64, 95% CI 0.29–1.37, p = 0.0001). The urinary catheter was removed within 6 hours after surgery in 74% patients in the ERAS group (OR 400.1, 95% CI 23.56–6796, p < 0.0001). The time to first oral liquid intake was a median of 8 hours in the ERAS group compared to 11 hours in the control group (p < 0.0001), and solid food intake occurred at a median of 24 hours in the ERAS group compared to 72 hours in the control group (p < 0.0001).CONCLUSIONSThis multidisciplinary, evidence-based, neurosurgical ERAS protocol for elective craniotomy appears to have significant benefits over conventional perioperative management. Implementation of ERAS is associated with a significant reduction in the postoperative hospital stay and an acceleration in recovery, without increasing complication rates related to elective craniotomy. Further evaluation of this protocol in large multicenter studies is warranted.Clinical trial registration no.: ChiCTR-INR-16009662 (chictr.org.cn)

WITHDRAWN: Successful implementation of an Enhanced Recovery After Surgery (ERAS) protocol reduces nausea and vomiting in patients after infratentorial craniotomy for tumour resection: a randomized controlled trial.

“…Our ERAS protocol for elective craniotomy focussed on enhanced recovery and shorter hospital stay after surgery [14]. It is well known that craniotomy can substantially disturb the homeostasis of the body and cause extensive surgical stress [34].…”

WITHDRAWN: Successful implementation of an Enhanced Recovery After Surgery (ERAS) protocol reduces nausea and vomiting in patients after infratentorial craniotomy: a randomized controlled trial

“…Our ERAS strategies incorporated recent evidence and expert opinions in designing the analgesic protocols [38,39]. Our previous study showed a significant improvement in pain control after surgery with ERAS implementation [14]. In addition, patients in the ERAS group were able to achieve earlier oral water/food intake, ambulation, and removal of the urinary catheter after surgery.…”

"RETRACTED ARTICLE:Successful implementation of an enhanced recovery after surgery (ERAS) protocol reduces nausea and vomiting after infratentorial craniotomy for tumour resection: a randomized controlled trial

“…The development of a novel, multidisciplinary, evidencebased, neurosurgical ERAS protocol for elective craniotomy was associated with shortened postoperative hospital length of stay and rapid recovery after surgery [14]. We also investigated whether the ERAS protocol was superior to conventional perioperative management in infratentorial craniotomy patients.…”

“…The cumulative incidence of vomiting over the 72 h post-craniotomy observation period was significantly lower in the ERAS group patients than in the control group patients. Cumulative incidence was calculated by the number of new cases during a period divided by the number of subjects at risk in the population Our ERAS protocol for elective craniotomy focussed on enhanced recovery and shorter hospital stay after surgery [14]. It is well known that craniotomy can substantially disturb the homeostasis of the body and cause extensive surgical stress [34].…”