Enhanced Recovery After Surgery for Craniotomies: A Systematic Review and Meta-analysis.

Area of Science:

• Neurosurgery
• Perioperative Care
• Evidence-Based Medicine

Background:

• Enhanced Recovery After Surgery (ERAS) protocols are increasingly adopted but their efficacy in neurosurgery, specifically craniotomy, remains unclear.
• Conventional perioperative care in craniotomy patients often involves prolonged hospital stays and significant postoperative morbidity.

Purpose of the Study:

• To systematically review and meta-analyze randomized controlled trials evaluating ERAS protocols versus conventional care for craniotomy patients.
• To assess the impact of ERAS on key postoperative outcomes including length of stay, pain, nausea, vomiting, and complications.

Main Methods:

• Systematic literature search of major databases (PubMed, Embase, Cochrane, Web of Science, Scopus) up to August 10, 2023.
• Meta-analysis of five randomized controlled trials involving 871 patients undergoing craniotomy.
• Primary outcome: postoperative length of hospital stay. Secondary outcomes: pain scores, PONV, complications, reoperation, readmission, and mortality.

Main Results:

• ERAS protocols significantly reduced postoperative hospital stay by a median of 1.52 days (95% CI: -2.55 to -0.49), with high heterogeneity (I²=74%).
• ERAS was associated with a lower risk of postoperative nausea and vomiting (RR 0.79, 95% CI: 0.69-0.90; I²=99%) and severe postoperative pain on day 1 (RR 0.37, 95% CI: 0.28-0.49; I²=14%).
• No significant differences were observed in postoperative complications, reoperation, readmission, or mortality between groups.

Conclusions:

• ERAS protocols demonstrate potential superiority over conventional care for craniotomy patients, evidenced by reduced hospital stay, lower PONV incidence, and improved pain management.
• Further high-quality randomized trials are warranted to confirm these benefits and evaluate the impact on overall quality of recovery.