Al Amiri Hospital, Kuwait City, Kuwait.
School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom.
Clin Neurol Neurosurg. 2024 Jan;236:108095. doi: 10.1016/j.clineuro.2023.108095. Epub 2023 Dec 21.
Enhanced Recovery After Surgery (ERAS) is a well-established, protocol-driven, evidence-based approach to peri-operative care. ERAS protocols have been used to improve patient morbidity and mortality outcomes in various surgical specialties. More recently, it has been introduced to neurosurgery. Our aim was to establish an Enhanced Recovery After Cranial Surgery (ERACraS) protocol for patients as part of a quality improvement project (QIP) with the intention of reducing hospital length of stay (HLOS).
This QIP was carried out in the Department of Neurosciences (DCN), Edinburgh, over two four-month periods. A total of 40 patients over 18 years of age undergoing elective craniotomy surgery under a sole neurosurgeon were invited to take part in this QIP. Subsequently, data was retrospectively collected through our institution's online documentation system.
19 patients received conventional perioperative care (pre-ERACraS group) during December 2021-March 2022, and 21 received care according to the novel ERACraS (ERACraS group) during June-September 2022. Regarding supra-tentorial surgery, there was a reduction of 73% in HLOS in the ERACraS group. No change was observed in infra-tentorial surgery. Overall, the ERACraS protocol reduced HLOS by 50% in cranial surgery.
The QIP data from ERACraS in our unit has shown that implementing ERAS protocols is feasible. A reduction in HLOS has implications for patient morbidity, mortality, and quality of care. We endeavour to collect long-term data by collaborating with neurosurgical units across the UK and Ireland to validate its feasibility and sustainability as part of a major QIP in neurosurgical practice. This can be potentially adopted by neurosurgical centres across the globe in a safe and sustained manner.
术后加速康复（ERAS）是一种成熟的、基于协议的、循证的围手术期护理方法。ERAS 方案已被用于改善各种外科专业的患者发病率和死亡率。最近，它已被引入神经外科。我们的目的是制定一个增强的颅外科后康复（ERACraS）方案，作为一项质量改进项目（QIP）的一部分，旨在缩短住院时间（HLOS）。
这项 QIP 在爱丁堡神经科学系（DCN）进行，分为两个四个月的阶段。共有 40 名 18 岁以上的患者在一名神经外科医生的手术下接受择期开颅手术，邀请他们参与这项 QIP。随后，通过我们机构的在线文档系统回顾性地收集数据。
2021 年 12 月至 2022 年 3 月期间，19 名患者接受了常规围手术期护理（ERACraS 前组），21 名患者根据新的 ERACraS 接受了护理（ERACraS 组）。在幕上手术中，ERACraS 组的 HLOS 减少了 73%。幕下手术没有变化。总的来说，ERACraS 方案使颅部手术的 HLOS 减少了 50%。
我们单位的 ERACraS 的 QIP 数据表明，实施 ERAS 方案是可行的。HLOS 的减少对患者的发病率、死亡率和护理质量有影响。我们努力通过与英国和爱尔兰的神经外科单位合作收集长期数据，以验证其在神经外科实践中的可行性和可持续性，作为一项主要的 QIP。这可以在全球范围内以安全和可持续的方式被神经外科中心采用。
