Department of Neurosurgery, Xi'an International Medical Center, Xi'an, China.
Department of Obstetrics and Gynecology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
Medicine (Baltimore). 2022 Aug 19;101(33):e30043. doi: 10.1097/MD.0000000000030043.
Population aging is an unprecedented, multifactorial, and global process that poses significant challenges to healthcare systems. Enhanced recovery after surgery (ERAS) protocols aim to optimize perioperative care. The first neurosurgical ERAS protocol for elective craniotomy has contributed to a shortened postoperative hospital stay, accelerated functional recovery, improved patient satisfaction, and reduced medical care cost in adult patients aged 18 to 65 years compared with conventional perioperative care. However, ERAS protocols for geriatric patients over 65 years of age undergoing cranial surgery are lacking. In this paper, we propose a novel ERAS protocol for such patients by reviewing and summarizing the key elements of successful ERAS protocols/guidelines and optimal perioperative care for geriatric patients described in the literature, as well as our experience in applying the first neurosurgical ERAS protocol for a quality improvement initiative. This proposal aimed to establish an applicable protocol for geriatric patients undergoing elective craniotomy, with evidence addressing its feasibility, safety, and potential efficacy. This multimodal, multidisciplinary, and evidence-based ERAS protocol includes preoperative, intraoperative, and postoperative assessment and management as well as outcome measures. The implementation of the current protocol may hold promise in reducing perioperative morbidity, enhancing functional recovery, improving postoperative outcomes in geriatric patients scheduled for elective craniotomy, and serving as a stepping stone to promote further research into the advancement of geriatric patient care.
人口老龄化是一个前所未有的、多因素的、全球性的过程，对医疗保健系统提出了重大挑战。增强术后恢复（ERAS）方案旨在优化围手术期护理。首个针对择期开颅手术的神经外科 ERAS 方案有助于缩短术后住院时间、加速功能恢复、提高患者满意度，并降低 18 至 65 岁成年患者的医疗费用，与常规围手术期护理相比。然而，针对 65 岁以上老年患者行颅部手术的 ERAS 方案却缺乏。在本文中，我们通过回顾和总结成功的 ERAS 方案/指南的关键要素以及文献中描述的老年患者最佳围手术期护理，以及我们在应用首个神经外科 ERAS 方案进行质量改进计划方面的经验，提出了一种针对此类患者的新型 ERAS 方案。该方案旨在为择期开颅手术的老年患者制定一个可行的方案，用证据证明其可行性、安全性和潜在疗效。该多模式、多学科和基于证据的 ERAS 方案包括术前、术中、术后评估和管理以及结果衡量。实施当前方案可能有助于降低围手术期发病率，增强老年择期开颅手术患者的功能恢复，改善术后结果，并为促进老年患者护理的进一步研究奠定基础。
