Enhanced recovery after surgery (ERAS) for elective glioma craniotomy: a propensity score-matched retrospective...

Although enhanced recovery after surgery (ERAS) has demonstrated benefits in various surgical specialties, evidence supporting its application in elective glioma craniotomies remains limited. This study compared the institutional ERAS pathway with conventional perioperative care in adults undergoing elective craniotomy for a single cerebral glioma. This retrospective cohort study (2019-2024) at a Thai university hospital enrolled patients aged ≥ 15 years with histologically confirmed gliomas. Propensity score matching (PSM; 1:1) addressed measured baseline confounding, and inverse probability of treatment weighting (IPTW) served as a sensitivity analysis. The primary outcomes were total hospital length of stay (LOS), intensive care unit (ICU) LOS, and postoperative LOS. Of 153 eligible patients (ERAS, n = 58; conventional, n = 95), PSM yielded 53 matched pairs. The ERAS group had shorter median total (9 vs. 12 days; p = 0.004) and postoperative (7 vs. 9 days; p = 0.037) LOS, with equivalent ICU LOS, hospitalization costs, and complication rates. The results of the IPTW analysis were directionally consistent. In multivariable logistic regression analyses, 2-hour preoperative carbohydrate loading (adjusted odds ratio [95% confidence interval] 5.98 [1.08-33.02], p = 0.040) and early oral fluid intake within postoperative 8 h (5.74 [1.22-26.96], p = 0.027) independently predicted a short postoperative LOS (< 7 days). Thus, ERAS was associated with shorter hospital stay without increased complications. Preoperative carbohydrate loading and early oral fluid intake were independently associated with a short postoperative LOS, identifying them as high-priority targets for a pragmatic, stepwise implementation strategy for ERAS in elective glioma craniotomies. Prospective multicenter studies are required to further optimize this pathway.