Enhanced Recovery After Surgery strategies for elective craniotomy: a systematic review

View More View Less
  • 1 Machine Intelligence in Clinical Neuroscience (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland;
  • | 2 Amsterdam UMC, Vrije Universiteit Amsterdam, Neurosurgery, Amsterdam Movement Sciences, Amsterdam, The Netherlands;
  • | 3 Center for Neuroscience, Queens University, Kingston, Ontario, Canada;
  • | 4 Department of Neurosurgery, Geneva University Hospital (HUG), Geneva, Switzerland;
  • | 5 Department of Neurosurgery, Bergman Clinics Amsterdam, The Netherlands;
  • | 6 Department of Neurosurgery, NYU Langone Hospital Brooklyn, New York; and
  • | 7 Department of Neurosurgery, Cantonal Hospital St. Gallen, Switzerland
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

OBJECTIVE

Enhanced Recovery After Surgery (ERAS) has led to a paradigm shift in perioperative care through multimodal interventions. Still, ERAS remains a relatively new concept in neurosurgery, and there is no summary of evidence on ERAS applications in cranial neurosurgery.

METHODS

The authors systematically reviewed the literature using the PubMed/MEDLINE, Embase, Scopus, and Cochrane Library databases for ERAS protocols and elements. Studies had to assess at least one pre-, peri-, or postoperative ERAS element and evaluate at least one of the following outcomes: 1) length of hospital stay, 2) length of ICU stay, 3) postoperative pain, 4) direct and indirect healthcare cost, 5) complication rate, 6) readmission rate, or 7) patient satisfaction.

RESULTS

A final 27 articles were included in the qualitative analysis, with mixed quality of evidence ranging from high in 3 cases to very low in 1 case. Seventeen studies reported a complete ERAS protocol. Preoperative ERAS elements include patient selection through multidisciplinary team discussion, patient counseling and education to adjust expectations of the postoperative period, and mental state assessment; antimicrobial, steroidal, and antiepileptic prophylaxes; nutritional assessment, as well as preoperative oral carbohydrate loading; and postoperative nausea and vomiting (PONV) prophylaxis. Anesthesiology interventions included local anesthesia for pin sites, regional field block or scalp block, avoidance or minimization of the duration of invasive monitoring, and limitation of intraoperative mannitol. Other intraoperative elements include absorbable skin sutures and avoidance of wound drains. Postoperatively, the authors identified early extubation, observation in a step-down unit instead of routine ICU admission, early mobilization, early fluid de-escalation, early intake of solid food and liquids, early removal of invasive monitoring, professional nutritional assessment, PONV management, nonopioid rescue analgesia, and early postoperative imaging. Other postoperative interventions included discharge criteria standardization and home visits or progress monitoring by a nurse.

CONCLUSIONS

A wide range of evidence-based interventions are available to improve recovery after elective craniotomy, although there are few published ERAS protocols. Patient-centered optimization of neurosurgical care spanning the pre-, intra-, and postoperative periods is feasible and has already provided positive results in terms of improved outcomes such as postoperative pain, patient satisfaction, reduced length of stay, and cost reduction with an excellent safety profile. Although fast-track recovery protocols and ERAS studies are gaining momentum for elective craniotomy, prospective trials are needed to provide stronger evidence.

ABBREVIATIONS

AED = antiepileptic drug; DSU = day surgery unit; ERAS = Enhanced Recovery After Surgery; GRADE = Grading of Recommendations Assessment, Development and Evaluation; HADS = Hospital Anxiety and Depression Scale; LOS = length of stay; PACU = postanesthesia care; PONV = postoperative nausea and vomiting; VAS = visual analog scale.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence Victor E. Staartjes: c/o Bergman Clinics, Naarden, The Netherlands. victor.staartjes@gmail.com.

INCLUDE WHEN CITING Published online May 7, 2021; DOI: 10.3171/2020.10.JNS203160.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Ljungqvist O, Scott M, Fearon KC. Enhanced Recovery After Surgery: a review. JAMA Surg. 2017;152(3):292298.

  • 2

    Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth. 1997;78(5):606617.

  • 3

    Fearon KCH, Ljungqvist O, Von Meyenfeldt M, et al. . Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr. 2005;24(3):466477.

    • Search Google Scholar
    • Export Citation
  • 4

    Lassen K, Soop M, Nygren J, et al. . Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg. 2009;144(10):961969.

    • Search Google Scholar
    • Export Citation
  • 5

    Coolsen MME, van Dam RM, van der Wilt AA, et al. . Systematic review and meta-analysis of enhanced recovery after pancreatic surgery with particular emphasis on pancreaticoduodenectomies. World J Surg. 2013;37(8):19091918.

    • Search Google Scholar
    • Export Citation
  • 6

    Corniola MV, Debono B, Joswig H, et al. . Enhanced recovery after spine surgery: review of the literature. Neurosurg Focus. 2019;46(4):E2.

  • 7

    Elsarrag M, Soldozy S, Patel P, et al. . Enhanced recovery after spine surgery: a systematic review. Neurosurg Focus. 2019;46(4):E3.

  • 8

    Mannaerts GHH, Allatif REA, Al Hashmi FY, et al. . First successful large-scale introduction of an enhanced recovery after bariatric surgery (ERABS) program in the Middle East: the results and lessons learned of Tawam Hospital/Johns Hopkins, a tertiary governmental center in the UAE. Obes Surg. 2019;29(7):21002109.

    • Search Google Scholar
    • Export Citation
  • 9

    McGinigle KL, Eldrup-Jorgensen J, McCall R, et al. . A systematic review of enhanced recovery after surgery for vascular operations. J Vasc Surg. 2019;70(2):629640.e1.

    • Search Google Scholar
    • Export Citation
  • 10

    Wang MY, Chang HK, Grossman J. Reduced acute care costs with the ERAS® minimally invasive transforaminal lumbar interbody fusion compared with conventional minimally invasive transforaminal lumbar interbody fusion. Neurosurgery. 2018;83(4):827834.

    • Search Google Scholar
    • Export Citation
  • 11

    Wang MY, Chang P-Y, Grossman J. Development of an Enhanced Recovery After Surgery (ERAS) approach for lumbar spinal fusion. J Neurosurg Spine. 2017;26(4):411418.

    • Search Google Scholar
    • Export Citation
  • 12

    Gustafsson UO, Hausel J, Thorell A, et al. . Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery. Arch Surg. 2011;146(5):571577.

    • Search Google Scholar
    • Export Citation
  • 13

    Staartjes VE, de Wispelaere MP, Schröder ML. Improving recovery after elective degenerative spine surgery: 5-year experience with an enhanced recovery after surgery (ERAS) protocol. Neurosurg Focus. 2019;46(4):E7.

    • Search Google Scholar
    • Export Citation
  • 14

    Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.

    • Search Google Scholar
    • Export Citation
  • 15

    Guyatt GH, Oxman AD, Vist GE, et al. . GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924926.

    • Search Google Scholar
    • Export Citation
  • 16

    Bernstein M. Outpatient craniotomy for brain tumor: a pilot feasibility study in 46 patients. Can J Neurol Sci. 2001;28(2):120124.

  • 17

    Boulton M, Bernstein M. Outpatient brain tumor surgery: innovation in surgical neurooncology. J Neurosurg. 2008;108(4):649654.

  • 18

    Grundy PL, Weidmann C, Bernstein M. Day-case neurosurgery for brain tumours: the early United Kingdom experience. Br J Neurosurg. 2008;22(3):360367.

    • Search Google Scholar
    • Export Citation
  • 19

    Ter Laan MT, Roelofs S, Van Huet I, et al. . Selective intensive care unit admission after adult supratentorial tumor craniotomy: complications, length of stay, and costs. Neurosurgery. 2020;86(1):E54E59.

    • Search Google Scholar
    • Export Citation
  • 20

    Ma R, Livermore LJ, Plaha P. Fast track recovery program after endoscopic and awake intraparenchymal brain tumor surgery. World Neurosurg.2016;93:246252.

    • Search Google Scholar
    • Export Citation
  • 21

    Purzner T, Purzner J, Massicotte EM, Bernstein M. Outpatient brain tumor surgery and spinal decompression: a prospective study of 1003 patients. Neurosurgery. 2011;69(1):119127.

    • Search Google Scholar
    • Export Citation
  • 22

    Wang Y, Liu B, Zhao T, et al. . Safety and efficacy of a novel neurosurgical enhanced recovery after surgery protocol for elective craniotomy: a prospective randomized controlled trial. J Neurosurg. 2018;130(5):16801691.

    • Search Google Scholar
    • Export Citation
  • 23

    Carrabba G, Venkatraghavan L, Bernstein M. Day surgery awake craniotomy for removing brain tumours: technical note describing a simple protocol. Minim Invasive Neurosurg. 2008;51(4):208210.

    • Search Google Scholar
    • Export Citation
  • 24

    McLaughlin N, Buxey F, Chaw K, Martin NA. Value-based neurosurgery: the example of microvascular decompression surgery. J Neurosurg. 2014;120(2):462472.

    • Search Google Scholar
    • Export Citation
  • 25

    Liu B, Wang Y, Liu S, et al. . A randomized controlled study of preoperative oral carbohydrate loading versus fasting in patients undergoing elective craniotomy. Clin Nutr. 2019;38(5):21062112.

    • Search Google Scholar
    • Export Citation
  • 26

    Au K, Bharadwaj S, Venkatraghavan L, Bernstein M. Outpatient brain tumor craniotomy under general anesthesia. J Neurosurg. 2016;125(5):11301135.

    • Search Google Scholar
    • Export Citation
  • 27

    Sughrue ME, Bonney PA, Choi L, Teo C. Early discharge after surgery for intra-axial brain tumors. World Neurosurg. 2015;84(2):505510.

    • Search Google Scholar
    • Export Citation
  • 28

    Yang X, Ma J, Li K, et al. . A comparison of effects of scalp nerve block and local anesthetic infiltration on inflammatory response, hemodynamic response, and postoperative pain in patients undergoing craniotomy for cerebral aneurysms: a randomized controlled trial. BMC Anesthesiol. 2019;19(1):91.

    • Search Google Scholar
    • Export Citation
  • 29

    Venkatraghavan L, Bharadwaj S, Au K, et al. . Same-day discharge after craniotomy for supratentorial tumour surgery: a retrospective observational single-centre study. Can J Anaesth. 2016;63(11):12451257.

    • Search Google Scholar
    • Export Citation
  • 30

    Akcil EF, Dilmen OK, Vehid H, et al. . Which one is more effective for analgesia in infratentorial craniotomy? The scalp block or local anesthetic infiltration. Clin Neurol Neurosurg. 2017;154:98103.

    • Search Google Scholar
    • Export Citation
  • 31

    Nassiri F, Li L, Badhiwala JH, et al. . Hospital costs associated with inpatient versus outpatient awake craniotomy for resection of brain tumors. J Clin Neurosci. 2019;59:162166.

    • Search Google Scholar
    • Export Citation
  • 32

    Goettel N, Chui J, Venkatraghavan L, et al. . Day surgery craniotomy for unruptured cerebral aneurysms: a single center experience. J Neurosurg Anesthesiol. 2014;26(1):6064.

    • Search Google Scholar
    • Export Citation
  • 33

    Bhagat H, Dash HH, Bithal PK, et al. . Planning for early emergence in neurosurgical patients: a randomized prospective trial of low-dose anesthetics. Anesth Analg. 2008;107(4):13481355.

    • Search Google Scholar
    • Export Citation
  • 34

    Bastola P, Bhagat H, Wig J. Comparative evaluation of propofol, sevoflurane and desflurane for neuroanaesthesia: a prospective randomised study in patients undergoing elective supratentorial craniotomy. Indian J Anaesth. 2015;59(5):287294.

    • Search Google Scholar
    • Export Citation
  • 35

    Djian M-C, Blanchet B, Pesce F, et al. . Comparison of the time to extubation after use of remifentanil or sufentanil in combination with propofol as anesthesia in adults undergoing nonemergency intracranial surgery: a prospective, randomized, double-blind trial. Clin Ther. 2006;28(4):560568.

    • Search Google Scholar
    • Export Citation
  • 36

    Gerlach K, Uhlig T, Hüppe M, et al. . Remifentanil-propofol versus sufentanil-propofol anaesthesia for supratentorial craniotomy: a randomized trial. Eur J Anaesthesiol. 2003;20(10):813820.

    • Search Google Scholar
    • Export Citation
  • 37

    Rajan S, Hutcherson MT, Sessler DI, et al. . The effects of dexmedetomidine and remifentanil on hemodynamic stability and analgesic requirement after craniotomy: a randomized controlled trial. J Neurosurg Anesthesiol. 2016;28(4):282290.

    • Search Google Scholar
    • Export Citation
  • 38

    Uchida K, Yasunaga H, Miyata H, et al. . Impact of remifentanil use on early postoperative outcomes following brain tumor resection or rectal cancer surgery. J Anesth. 2012;26(5):711720.

    • Search Google Scholar
    • Export Citation
  • 39

    McLaughlin N, Upadhyaya P, Buxey F, Martin NA. Value-based neurosurgery: measuring and reducing the cost of microvascular decompression surgery. J Neurosurg. 2014;121(3):700708.

    • Search Google Scholar
    • Export Citation
  • 40

    Cata JP, Saager L, Kurz A, Avitsian R. Successful extubation in the operating room after infratentorial craniotomy: the Cleveland Clinic experience. J Neurosurg Anesthesiol. 2011;23(1):2529.

    • Search Google Scholar
    • Export Citation
  • 41

    Liu B, Liu S, Wang Y, et al. . Neurosurgical enhanced recovery after surgery (ERAS) programme for elective craniotomies: are patients satisfied with their experiences? A quantitative and qualitative analysis. BMJ Open. 2019;9(11):e028706.

    • Search Google Scholar
    • Export Citation
  • 42

    Wang MY, Tessitore E, Berrington N, Dailey A. Introduction. Enhanced recovery after surgery (ERAS) in spine. Neurosurg Focus. 2019;46(4):E1.

    • Search Google Scholar
    • Export Citation
  • 43

    Brusko GD, Kolcun JPG, Heger JA, et al. . Reductions in length of stay, narcotics use, and pain following implementation of an enhanced recovery after surgery program for 1- to 3-level lumbar fusion surgery. Neurosurg Focus. 2019;46(4):E4.

    • Search Google Scholar
    • Export Citation
  • 44

    Debono B, Corniola MV, Pietton R, et al. . Benefits of Enhanced Recovery After Surgery for fusion in degenerative spine surgery: impact on outcome, length of stay, and patient satisfaction. Neurosurg Focus. 2019;46(4):E6.

    • Search Google Scholar
    • Export Citation
  • 45

    Feng C, Zhang Y, Chong F, et al. . Establishment and implementation of an enhanced recovery after surgery (ERAS) pathway tailored for minimally invasive transforaminal lumbar interbody fusion surgery. World Neurosurg.2019;129:e317e323.

    • Search Google Scholar
    • Export Citation
  • 46

    Liu B, Liu S, Wang Y, et al. . Enhanced recovery after intraspinal tumor surgery: a single-institutional randomized controlled study. World Neurosurg.2020;136:e542–e552.

    • Search Google Scholar
    • Export Citation
  • 47

    Dietz N, Sharma M, Adams S, et al. . Enhanced recovery after surgery (ERAS) for spine surgery: a systematic review. World Neurosurg.2019;130:415426.

    • Search Google Scholar
    • Export Citation
  • 48

    Hagan KB, Bhavsar S, Raza SM, et al. . Enhanced recovery after surgery for oncological craniotomies. J Clin Neurosci. 2016;24:1016.

  • 49

    Sheshadri V, Venkatraghavan L, Manninen P, Bernstein M. Anesthesia for same day discharge after craniotomy: review of a single center experience. J Neurosurg Anesthesiol. 2018;30(4):299304.

    • Search Google Scholar
    • Export Citation
  • 50

    Akhigbe T, Zolnourian A. Use of regional scalp block for pain management after craniotomy: review of literature and critical appraisal of evidence. J Clin Neurosci. 2017;45:4447.

    • Search Google Scholar
    • Export Citation
  • 51

    Badie B, Brooks N, Souweidane MM. Endoscopic and minimally invasive microsurgical approaches for treating brain tumor patients. J Neurooncol. 2004;69(1-3):209219.

    • Search Google Scholar
    • Export Citation
  • 52

    Caplan JM, Papadimitriou K, Yang W, et al. . The minipterional craniotomy for anterior circulation aneurysms: initial experience with 72 patients. Neurosurgery. 2014;10(suppl2):200207.

    • Search Google Scholar
    • Export Citation
  • 53

    Cappabianca P, de Divitiis E. Endoscopy and transsphenoidal surgery. Neurosurgery. 2004;54(5):10431050.

  • 54

    Esposito G, Dias SF, Burkhardt J-K, et al. . Selection strategy for optimal keyhole approaches for middle cerebral artery aneurysms: lateral supraorbital versus minipterional craniotomy. World Neurosurg.2019;122:e349e357.

    • Search Google Scholar
    • Export Citation
  • 55

    Perneczky A, Fries G. Endoscope-assisted brain surgery: part 1—evolution, basic concept, and current technique. Neurosurgery. 1998;42(2):219225.

    • Search Google Scholar
    • Export Citation
  • 56

    Spetzler RF, Sanai N. The quiet revolution: retractorless surgery for complex vascular and skull base lesions. J Neurosurg. 2012;116(2):291300.

    • Search Google Scholar
    • Export Citation
  • 57

    Yan H, Karmur BS, Kulkarni AV. Comparing effects of treatment: controlling for confounding. Neurosurgery. 2020;86(3):325331.

  • 58

    Brock S, Saleh C, Zekaj E, Servello D. How to compare clinical results of different neurosurgical centers? Is a classification of complications in neurosurgery necessary for this purpose?. Surg Neurol Int. 2016;7(21)(suppl 20):S565S569.

    • Search Google Scholar
    • Export Citation
  • 59

    Sarnthein J, Stieglitz L, Clavien P-A, Regli L. A patient registry to improve patient safety: recording general neurosurgery complications. PLoS One. 2016;11(9):e0163154.

    • Search Google Scholar
    • Export Citation
  • 60

    Brown TJ, Brennan MC, Li M, et al. . Association of the extent of resection with survival in glioblastoma: a systematic review and meta-analysis. JAMA Oncol. 2016;2(11):14601469.

    • Search Google Scholar
    • Export Citation
  • 61

    Jackson C, Choi J, Khalafallah AM, et al. . A systematic review and meta-analysis of supratotal versus gross total resection for glioblastoma. J Neurooncol. 2020;148(3):419431.

    • Search Google Scholar
    • Export Citation
  • 62

    Garrett M, Consiglieri G, Nakaji P. Transcranial minimally invasive neurosurgery for tumors. Neurosurg Clin N Am. 2010;21(4):595605, v.

    • Search Google Scholar
    • Export Citation
  • 63

    van Niftrik CHB, van der Wouden F, Staartjes VE, et al. . Machine learning algorithm identifies patients at high risk for early complications after intracranial tumor surgery: registry-based cohort study. Neurosurgery. 2019;85(4):E756E764.

    • Search Google Scholar
    • Export Citation
  • 64

    Beauregard CL, Friedman WA. Routine use of postoperative ICU care for elective craniotomy: a cost-benefit analysis. Surg Neurol. 2003;60(6):483489.

    • Search Google Scholar
    • Export Citation
  • 65

    Todd M, Warner DS, Sokoll MD, et al. . A prospective, comparative trial of three anesthetics for elective supratentorial craniotomy: propofol/fentanyl, isoflurane/nitrous oxide, and fentanyl/nitrous oxide. Anesthesiology. 1993;78(6):10051020.

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 650 650 242
Full Text Views 109 109 47
PDF Downloads 126 126 73
EPUB Downloads 0 0 0