Enhanced Recovery After Surgery (ERAS) Versus Standard Postoperative Care in Elective Craniotomy for Brain Tumor...

Standard postoperative care following elective craniotomy traditionally includes close monitoring in an ICU setting, use of opioid-based analgesia, delayed initiation of oral intake, and prolonged bed rest. These practices may contribute to a longer recovery period, a higher risk of complications such as infections or deep vein thrombosis (DVT), and lower patient satisfaction. On the other hand, Enhanced Recovery After Surgery (ERAS) protocols offer a more structured and proactive approach. It incorporates preoperative counseling, carbohydrate loading (if appropriate), avoidance of prolonged fasting, and standardized anesthetic techniques that prefer shorter-acting agents. Postoperatively, ERAS prioritizes early removal of catheters and drains, early enteral diet, and rapid mobilization - all designed to help patients recover more efficiently. Across the literature reviewed here, ERAS is associated with concrete gains over standard care: postoperative nausea and vomiting falling from roughly 28.0% to 9.2% in one cohort, a Karnofsky Performance Status improvement of approximately 10 points sustained at 30 days (pooled mean difference 6.68 points), patient satisfaction of 92.2% versus 86.8%, ICU length of stay reduced to under one day, and per-patient cost reductions of $1,044-$4,026. Hospitals must undertake protocol development, arrange training, and ensure flexibility to adapt ERAS elements to each patient's clinical needs; implementation remains uneven across economic and resource settings, particularly in low- and middle-income countries. As interest in ERAS grows, further research and education will be essential to support wider and more effective practice across neurosurgical practices.