Zaed Ismail, Marchi Francesco, Milani Davide, Cabrilo Ivan, Cardia Andrea
Department of Neurosurgery, Neurocenter of South Switzerland, EOC, via Tesserete 44, 6900 Lugano, Switzerland.
J Clin Med. 2023 Sep 18;12(18):6032. doi: 10.3390/jcm12186032.
Among the already difficult management of neuro-oncological patients, the elderly population remains vulnerable. Because of the pathology and the comorbidities, they present a significantly higher rate of medical issues related to surgical management. Despite this, the surgical option, if feasible, remains the gold standard in these patients, and an Enhanced Recovery After Surgery (ERAS) protocol could improve the postoperative safety of the patients. With this purpose, we prepared this study with the aim of defining the postoperative hospital length of stay (LOS), but also of evaluating the postoperative morbidity, perioperative complications, and postoperative pain scores.
This was a retrospective, single-cohort study performed at an academic hospital (Department of Neurosurgery, Neurocenter of South Switzerland, Switzerland) on elderly patients who underwent craniotomy for glioblastoma. Patients were enrolled in a novel ERAS protocol from January 2022 to December 2022. Since this is a feasibility study and a direct comparison was not possible, we used a historical cohort of elderly patients who had undergone elective craniotomy surgery for glioblastoma as a control group.
A total of 19 patients treated in our center for glioblastoma multiforme (GBM) who were aged over 75 years were included in this study. Among those, seven were newly recruited patients included in the ERAS protocol, while the remaining twelve were part of a historical cohort of previously treated patients. From a statistical point of view, the two cohorts were comparable in terms of baseline demographics. In the follow-up, it was shown that in the ERAS group, there was a reduction in the use of opioids after the surgical procedures that could be seen at 30 days (36.2% vs. 71.7%, < 0.001), but also at 3 months, after surgery (33.0% vs. 80.0%, < 0.001). A significant difference has also been documented in terms of mobilization and ambulation: compared to the historical cohort, in the ERAS group, there was a higher rate of mobilization (60.0% vs. 10.0%, < 0.001), but also of ambulation (36.1% vs. 10.0%, < 0.001).
The ERAS protocol for the management of glioblastoma in elderly patients seems to be an effective option for reducing LOS in the hospital, as well as for reducing the number of days spent in the ICU, improving the general recovery of the patient, and reducing the costs associated with hospitalization.
在神经肿瘤患者本就困难的管理中，老年人群体仍然较为脆弱。由于其病情和合并症，他们在手术管理方面出现医疗问题的比率显著更高。尽管如此，手术选择若可行，仍是这些患者的金标准，而术后加速康复（ERAS）方案可提高患者术后安全性。出于此目的，我们开展了本研究，旨在确定术后住院时长（LOS），同时评估术后发病率、围手术期并发症及术后疼痛评分。
这是一项在一家学术医院（瑞士南部神经中心神经外科）针对因胶质母细胞瘤接受开颅手术的老年患者开展的回顾性单队列研究。患者于2022年1月至2022年12月纳入一项新的ERAS方案。由于这是一项可行性研究且无法进行直接比较，我们将一组因胶质母细胞瘤接受择期开颅手术的老年患者作为历史队列作为对照组。
本研究纳入了我院共19例年龄超过75岁的多形性胶质母细胞瘤（GBM）患者。其中，7例为新纳入ERAS方案的患者，其余12例是既往治疗患者历史队列的一部分。从统计学角度看，两个队列在基线人口统计学方面具有可比性。在随访中发现，在ERAS组，术后30天（36.2%对71.7%，<0.001）以及术后3个月（33.0%对80.0%，<0.001）时，手术操作后阿片类药物的使用有所减少。在活动和行走方面也记录到显著差异：与历史队列相比，ERAS组的活动率更高（60.0%对10.0%，<0.001），行走率也更高（36.1%对10.0%，<0.001）。
老年患者胶质母细胞瘤管理的ERAS方案似乎是减少住院时长、减少在重症监护病房停留天数、改善患者总体恢复情况以及降低住院相关费用的有效选择。
