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Published on: May 9, 2022
Enhanced Recovery After Adult Brain Tumor Surgery: A Proposed Succinct Evidence-Based Protocol
Alejandro Carrasquilla1, Zerubabbel K Asfaw1, Lewis E Tomalin2
1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York , New York , USA.
Background And Objectives:
Enhanced recovery after surgery (ERAS) for brain tumor surgery holds promise for improving outcomes. However, its lack of standardization has led to financial and logistic barriers, hindering its widespread adoption and optimization. This study seeks to identify ERAS variables across the preoperative, intraoperative, and postoperative phases associated with shorter hospital length of stay (LOS), decreased postoperative pain, and reduced costs.
Methods:
A comprehensive literature search was performed to include MEDLINE, Embase, Cochrane Library, and Scopus from January 1, 2020, to December 31, 2023. Eligible studies were selected based on predefined inclusion/exclusion criteria. Additional references were hand-picked by the authors when appropriate. Statistical methods were used to identify variables linked to improved outcomes, such as LOS, cost, and pain control.
Results:
Of the 278 abstracts, 50 met eligibility criteria, leading to 16 final full-text articles for the study, covering 2296 patients. Variables significantly reducing LOS on multivariable regression analysis included preoperative social assessment for discharge planning (β = -3.95, CI: -5.45 to -2.45, P < .001), nutritional counseling and preoperative optimization (β = -1.90, CI: -2.98 to -0.81, P < .01), intraoperative prophylactic antibiotics (β = -2.41, CI: -4.98 to 0.15, P < .06), extubation in the operating room (β = -4.39, CI: -8.36 to -0.42, P = .033), postoperative patient education on discharge instructions (β = -3.9, CI: -6.24 to -1.56, P < .01), opiate-sparing analgesia (β = -2.8, CI: -4.93 to 0.67, P = .017), and early mobility (β = -1.95, CI: -3.86 to -0.04, P = .046). Multivariable logistic regression demonstrated that ERAS protocols with a local/regional anesthetic block during the intraoperative period significantly predicted a pain benefit (odds ratio = 28, CI: 1.95 to 181.2, P = .03).
Conclusion:
Based on the results from the present analysis, the authors synthesize an ERAS protocol for patients undergoing brain tumor surgery with key elements that demonstrated a significant influence on the measured outcomes.
