Dr. Kiran C. Patel College of Osteopathic Medicine Davie, FL, USA.
Neurosurgery, Cleveland Clinic Florida, Weston, FL, USA.
Clin Neurol Neurosurg. 2023 Jul;230:107757. doi: 10.1016/j.clineuro.2023.107757. Epub 2023 May 5.
Patients with idiopathic normal pressure hydrocephalus (iNPH) who undergo ventriculoperitoneal shunt (VPS) placement often belong to an older demographic, putting them at increased risk of postoperative delirium and related complications. Recent literature documenting the use of Enhanced Recovery After Surgery (ERAS) protocols in various disciplines of surgery has shown improved clinical outcomes, faster discharge, and lower readmission rates. Early return to a familiar environment (i.e., discharged home) is a well-known predictor of reduced postoperative delirium. However, ERAS protocols are uncommon in neurosurgery, especially intracranial procedures. We developed a novel ERAS protocol for patients with iNPH undergoing VPS placement to gain further insight regarding postoperative complications, specifically delirium.
We studied 40 patients with iNPH with indications for VPS. Seventeen patients were selected at random to undergo the ERAS protocol, and twenty-three patients underwent the standard VPS protocol. The ERAS protocol consisted of measures to reduce infection, manage pain, minimize invasiveness, confirm procedural success with imaging, and shorten the length of stay. Pre-operative American Society of Anesthesiologists (ASA) grade was collected for each patient to indicate baseline risk. Rates of readmission and postoperative complications, including delirium and infection, were collected at 48 h, 2 weeks, and 4 weeks postoperatively.
There were no perioperative complications among the 40 patients. There was no postoperative delirium in any of the ERAS patients. Postoperative delirium was observed in 10 of 23 non-ERAS patients. There was no statistically significant difference between the ASA grade between the ERAS and non-ERAS groups.
We described a novel ERAS protocol for patients with iNPH receiving VPS focusing on an early discharge. Our data suggest that ERAS protocols in VPS patients might reduce the incidence of delirium without increasing the risk of infection or other postoperative complications.
接受脑室腹腔分流术 (VPS) 的特发性正常压力脑积水 (iNPH) 患者通常属于年龄较大的人群，因此术后谵妄和相关并发症的风险增加。最近有文献记录了在外科的各个学科中使用增强术后恢复 (ERAS) 方案，这些方案显示出改善的临床结果、更快的出院和更低的再入院率。尽早返回熟悉的环境（即出院回家）是降低术后谵妄的一个众所周知的预测因素。然而，ERAS 方案在神经外科中并不常见，尤其是颅内手术。我们为接受 VPS 治疗的 iNPH 患者制定了一种新的 ERAS 方案，以进一步了解术后并发症，特别是谵妄。
我们研究了 40 例有 VPS 适应证的 iNPH 患者。随机选择 17 例患者接受 ERAS 方案，23 例患者接受标准 VPS 方案。ERAS 方案包括减少感染、管理疼痛、最小化侵袭性、通过影像学确认手术成功和缩短住院时间的措施。收集每位患者的术前美国麻醉医师协会 (ASA) 分级，以表明基线风险。在术后 48 小时、2 周和 4 周时收集再入院率和术后并发症（包括谵妄和感染）的发生率。
40 例患者均无围手术期并发症。在接受 ERAS 的患者中，没有出现术后谵妄。在非 ERAS 组的 23 例患者中，有 10 例出现术后谵妄。ERAS 组和非 ERAS 组之间的 ASA 分级没有统计学差异。
我们描述了一种新型的 ERAS 方案，用于接受 VPS 的 iNPH 患者，重点是早期出院。我们的数据表明，ERAS 方案在 VPS 患者中可能降低谵妄的发生率，而不会增加感染或其他术后并发症的风险。
