Beijing Tiantan Hospital, Capital Medical University, China.
Department of Rehabilitation Medicine, Peking University Third Hospital, China.
Brain Res. 2023 Oct 1;1816:148467. doi: 10.1016/j.brainres.2023.148467. Epub 2023 Jun 20.
Enhanced recovery after surgery (ERAS) is a multidisciplinary,and evidence-based perioperative care method. It is effective in shortening hospital stays and improving clinical outcomes. However, the application of ERAS in craniotomy lacks reliable evidence. The purpose of this study is to investigate the efficacy and safety of ERAS in craniotomy.
Studies of ERAS in craniotomy were systematically searched in PubMed, Embase, Cochrane, and Web of Science. Primary outcomes (total hospital stay and postoperative hospital stay, hospitalization cost, percent of patients with moderate to severe pain) and secondary outcomes (readmission rate and incidence of complication) were compared between ERAS and traditional perioperative care.
Of the 10 studies included in this meta-analysis, 6 were randomized-controlled trials (RCTs), 3 were cohort studies, and 1 was non-RCT. A total of 1275 patients were included, with 648 in the ERAS group and 627 in the control group. Compared with the control group, the ERAS group had a significantly shortened total length of stay (LOS) (MD = -2.437, 95% CI: -3.616, -1.077, P = 0.001) and postoperative LOS, reduced hospitalization cost (SMD = -0.631, 95% CI: -0.893, -0.369, P = 0.001), and lower percent of patients with moderate to severe pain. There was no significant difference in readmission rate between the two groups. Though, the ERAS group had a significantly lower risk of pneumonia than the control group.
ERAS is safe and effective for craniotomy as it shortens total and postoperative LOS, reduces hospitalization costs, decreases the percent of patients with moderate to severe pain.
加速康复外科（ERAS）是一种多学科、基于证据的围手术期护理方法。它可有效缩短住院时间，改善临床结局。但 ERAS 在开颅术中的应用缺乏可靠的证据。本研究旨在探讨 ERAS 在开颅术中的疗效和安全性。
系统检索 PubMed、Embase、Cochrane、Web of Science 中关于 ERAS 在开颅术中应用的研究。比较 ERAS 与传统围手术期护理在总住院时间和术后住院时间、住院费用、中重度疼痛患者比例等主要结局及再入院率和并发症发生率等次要结局方面的差异。
本 meta 分析共纳入 10 项研究，其中 6 项为随机对照试验（RCT），3 项为队列研究，1 项为非 RCT。共纳入 1275 例患者，其中 ERAS 组 648 例，对照组 627 例。与对照组相比，ERAS 组总住院时间（LOS）[MD=-2.437，95%CI：-3.616，-1.077，P=0.001]和术后 LOS 更短，住院费用更低[SMD=-0.631，95%CI：-0.893，-0.369，P=0.001]，中重度疼痛患者比例更低。两组再入院率无显著差异，但 ERAS 组肺炎发生率显著低于对照组。
ERAS 应用于开颅术安全有效，可缩短总住院时间和术后住院时间，降低住院费用，减少中重度疼痛患者比例。
