Enhanced recovery after neurosurgery

The enhanced recovery after surgery (ERAS) approach to the surgical patient optimizes perioperative care to improve outcomes and facilitate recovery. Despite the success of ERAS in many surgical specialties, neurosurgery has been reluctant to adopt ERAS. The aim of this review was to examine recently published ERAS protocols for elective neurosurgical procedures with a focus on brain and spine surgeries.

There were few ERAS protocols published for brain and spine surgery in comparison to other surgical specialties. ERAS elements specific to brain surgery seem to address thromboprophylaxis planning, antiepileptic management, steroid administration, strict blood pressure control, and avoidance of mannitol. When implemented, protocols have yielded similar results to protocols for other surgical specialties, including reduced morbidity, hospital length of stay, and health care cost. However, widespread implementation was limited by difficulties in obtaining a consensus agreement on ERAS elements to include, achieving adoption across neurosurgeons, and protocol adherence.

While the adoption of ERAS in neurosurgery remains limited, emerging evidence supports its feasibility and effectiveness, particularly in reducing hospitalization costs and postoperative complications.