Choudhary Suresh Kumar, Bijarniya Dinesh, Jat Shravan Kumar, Agrawal Manish, Vasudeva Shubham
Department of Neurosurgery, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, 302004, India.
Department of Anesthesia, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, 302004, India.
Neurosurg Rev. 2025 Mar 10;48(1):291. doi: 10.1007/s10143-025-03446-9.
Enhanced recovery after surgery protocol (ERASP) improves postoperative outcomes. However, its implementation in neurosurgery remains under explored, resulting in the absence of standard evidence-based guidelines. Thus, we compared the outcomes of ERASP and conventional perioperative care (CPC) in patients undergoing elective craniotomy for various intracranial pathologies. This systematic review and meta-analysis involved the search of PubMed, Cochrane Library, and Google Scholar until December 4, 2024. The primary outcomes were total and postoperative length of stay (LOS). Secondary outcomes included hospitalization cost, pain, analgesic use, Karnofsky performance status (KPS) score, postoperative nausea and vomiting (PONV), postoperative complications, 30-days readmission and reoperation, and mortality. A total of 15 studies, including randomized controlled trials (n = 9) as well as prospective and retrospective studies (each n = 3) were included. Compared to CPC, ERASP significantly reduced total LOS (MD -3.32, 95%CI -3.66 to -2.98; P < 0.0001, I = 34%), postoperative LOS (MD -2.80, 95%CI -3.82 to -1.79; P < 0.0001, I = 90%), hospitalization cost (MD -$1044, 95%CI -$1289 to -$800; P < 0.0001, I = 47%), postoperative pain (MD -1.55, 95%CI -1.92 to -1.19; P < 0.0001, I = 83%), analgesic use (OR 0.56, 95%CI 0.40 to 0.80; P = 0.001, I = 0%), KPS score (MD 6.68, 95%CI 0.15 to 13.21; P = 0.045, I = 93%), respiratory complications (OR 0.28, 95%CI 0.13 to 0.58; P = 0.001, I = 0%), and PONV (OR 0.39, 95%CI 0.27 to 0.57; P < 0.0001, I = 0%). While ERASP and CPC were comparable regarding other outcome measures. Thus, in elective craniotomy, ERASP shortens total and postoperative LOS, decreases hospitalization costs, improves functional recovery, decreases pain and analgesic use, with reduced incidence of PONV and respiratory complications.
术后加速康复方案（ERASP）可改善术后结局。然而，其在神经外科手术中的应用仍有待探索，导致缺乏基于证据的标准指南。因此，我们比较了接受各种颅内病变择期开颅手术患者的ERASP和传统围手术期护理（CPC）的结局。这项系统评价和荟萃分析涉及检索截至2024年12月4日的PubMed、Cochrane图书馆和谷歌学术。主要结局为总住院时间和术后住院时间（LOS）。次要结局包括住院费用、疼痛、镇痛药物使用、卡氏功能状态评分（KPS）、术后恶心呕吐（PONV）、术后并发症、30天再入院和再次手术以及死亡率。共纳入15项研究，包括随机对照试验（n = 9）以及前瞻性和回顾性研究（各n = 3）。与CPC相比，ERASP显著缩短了总住院时间（MD -3.32，95%CI -3.66至-2.98；P < 0.0001，I = 34%）、术后住院时间（MD -2.80，95%CI -3.82至-1.79；P < 0.0001，I = 90%）、住院费用（MD -1044美元，95%CI -1289至-800美元；P < 0.0001，I = 47%）、术后疼痛（MD -1.55，95%CI -1.92至-1.19；P < 0.0001，I = 83%）、镇痛药物使用（OR 0.56，95%CI 0.40至0.80；P = 0.001，I = 0%）、KPS评分（MD 6.68，95%CI 0.15至13.21；P = 0.045，I = 93%）、呼吸并发症（OR 0.
