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Identifying Components Necessary for an Enhanced Recovery After Surgery Pathway for Elective Intracranial Surgery: An

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Improving postoperative recovery after intracranial surgery is crucial. Targeted interventions, like intravenous acetaminophen for pain, significantly enhanced patient well-being and analgesia, leading to better overall recovery scores.

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Area of Science:

  • Anesthesiology and Perioperative Medicine
  • Surgical Recovery Science
  • Quality Improvement in Healthcare

Background:

  • Postoperative recovery after intracranial surgery is complex and impacts patient outcomes.
  • The Quality of Recovery-15 (QoR-15) score is a validated tool for assessing patient recovery.
  • Identifying specific recovery domains needing improvement is essential for developing targeted interventions.

Purpose of the Study:

  • To identify key domains of postoperative recovery that require enhancement in patients undergoing elective intracranial surgery.
  • To develop and implement initial interventions for an enhanced recovery after surgery (ERAS) protocol based on identified recovery deficits.
  • To evaluate the impact of these interventions on patient recovery trajectories.

Main Methods:

  • A paired-availability design was employed, assessing two groups of 41 patients undergoing elective intracranial surgery.
  • Postoperative recovery was characterized using the QoR-15 score at baseline and at 0, 6, 12, and 24 hours post-ICU arrival.
  • Pharmacologic interventions were implemented in the postimplementation group targeting the lowest scoring QoR-15 domains identified in the preimplementation group.

Main Results:

  • Postoperative analgesia and postoperative nausea and vomiting were identified as the lowest scoring domains of recovery.
  • Pharmacologic interventions included oral aprepitant for nausea/vomiting and intravenous acetaminophen for analgesia, chosen for minimal sedation and ease of administration.
  • Clinically and statistically significant improvements in analgesia were observed upon ICU arrival and at 6 hours postoperatively. Total QoR-15 scores improved up to the 12-hour time point.

Conclusions:

  • The QoR-15 score effectively identified specific recovery domains that impede patient progress after intracranial surgery.
  • The implementation of targeted pharmacologic interventions, specifically intravenous acetaminophen, significantly improved patient well-being and analgesia.
  • This quality improvement project demonstrates the utility of the QoR-15 score in guiding the development of effective ERAS protocols for neurosurgical patients.