Comparison of Enhanced Recovery After Surgery Protocol Versus Conventional Care in Patients Undergoing Craniotomy for...

Enhanced recovery after surgery (ERAS) is a perioperative multimodal approach aimed at improving post-surgery functional outcomes. Its implementation in patients with intracranial aneurysms undergoing craniotomy is insufficient. Hence, we aimed to investigate whether the ERAS protocol is better than the conventional protocol in terms of favorable outcomes. The primary outcome of the study was postoperative hospital length of stay (LOS). The secondary outcomes included intraoperative fentanyl consumption, postoperative pain assessment and analgesic requirement, length of intensive care unit (ICU) stay, postoperative complications, functional recovery, and patient satisfaction.

American Society of Anesthesiologists (ASA) grade I or II patients with anterior circulation aneurysms (18-65 years) with World Federation of Neurosurgical Societies (WFNS) grade 1 were enrolled and randomized into 2 groups: ERAS group (group E) or conventional group (group C) using computer-generated sequence numbers. Exclusion criteria included nonconsenting patients, posterior circulation aneurysms, WFNS grades 2, 3, 4, and 5, age <18 or >65 years, ASA grade III, IV, V, pregnant patients, patients requiring postoperative ventilation, history of brain surgery, preoperative cognitive dysfunction, and body mass index (BMI) >40. Quantitative data underwent analysis via t test or Mann-Whitney U test, while qualitative data were subjected to χ2 test or Z test of proportions. The value of P < .05 was considered significant.

A total of 46 patients were analyzed for the study, 23 in each group. Demographics and baseline characteristics were comparable between the groups. The mean ± standard deviation (mean ± SD) of LOS in group E was 8.0 ± 2.4 days and those were in group C was 8.9 ± 2.7 days, which were comparable (difference 0.9 [95% confidence interval {CI}, -2.32 to 0.67; P = .28]). The duration of the mean ICU stay was shorter in group E in comparison to those in group C (20.9 ± 6.8 hours vs 28.9 ± 9.0 hours; difference 8; 95% CI, 12.7 to -3.37; P = .001). The additional intraoperative fentanyl requirement was significantly lower in group E in comparison to those in group C (132 ± 40 vs 183 ± 39 µg; difference 51, 95% CI, -73.8 to -27.0; P < .001). The median (interquartile range [IQR]) patient satisfaction scores were significantly higher in group E in comparison to group C (4 [3-5] vs 3 [2-4]; difference 1; 95% CI, 0-2; P < .001).

ERAS protocol within the domain of intracranial aneurysm surgery results in early ICU discharge, augmented patient satisfaction, improved postoperative pain scores, and a potentially higher score in functional recovery.