Retraction Note: Successful implementation of an enhanced recovery after surgery (ERAS) protocol reduces nausea and vomiting after infratentorial craniotomy for tumour resection: a randomized controlled trial

Enhanced Recovery After Surgery (ERAS) Protocol for Craniotomy Patients: A Systematic Review

Context

The enhanced recovery after surgery (ERAS) protocol is a multidisciplinary approach aimed at improving surgical outcomes, reducing complications, minimizing hospital stays, and lowering healthcare costs.

Objectives

This study assesses the impact of the ERAS protocol on elective craniotomies, a routine procedure in neurosurgery.

Methods

A comprehensive search across PubMed, Embase, Scopus, and Web of Science identified 562 articles. Following strict screening criteria, 54 studies were reviewed, and ultimately 10 studies meeting the inclusion criteria were selected for detailed analysis.

Results

The review encompassed ten studies [one prospective, one systematic review, and eight randomized controlled trials (RCTs)] published between 2016 and 2023. Key components of the ERAS protocol included preoperative counseling, high-protein intestinal nutrition, preoperative fasting while avoiding carbohydrate intake within 2 hours of surgery, standardized anesthetic and analgesic regimens, and early postoperative initiation of enteral feeding. Postoperative outcomes showed fewer complications, early mobilization, and notably shorter hospital stays, all of which contributed to improved patient recovery.

Conclusions

This review demonstrates that the ERAS protocol, when applied to elective craniotomies, is effective in enhancing postoperative recovery, improving functional outcomes, and reducing hospitalization duration.

Placement of Wound Drain After Anterior Circulation Aneurysm Clipping: A Single-Center Retrospective Study

OBJECTIVE

Wound drain used to be a routine procedure after craniotomy for aneurysm clipping, although this was not based on clinical evidence. The purpose of our study was to determine the necessity of wound drain placement after anterior circulation aneurysm surgery.

METHODS

Retrospective analysis of patients with anterior circulation aneurysms treated by clipping in the Department of Neurosurgery, Wuhan University Zhongnan hospital from January 2019 to December 2019 was carried out. Demographic and clinical data, including age, sex, body mass index, disease history, results of the laboratory and imaging examinations, and surgical logs, were reviewed.

RESULTS

A total of 236 patients (90 male and 146 female) were included in the analysis and were divided into a Drain group and a No Drain group according to whether postoperative wound drainage was applied. There was no statistical difference in the incidence of a postoperative extradural hematoma between patients in the 2 groups. However, the incidence of postoperative meningitis was higher in the Drain group than in the No Drain group (9.09% vs. 1.59%, P = 0.009), and the total length of stay and postoperative length of stay in the Drain group were also more extended than in the No Drain group (17.32 ± 6.45 vs. 14.43 ± 5.75, P = 0.005; 12.83 ± 5.07 vs. 9.82 ± 4.50, P = 0.007, respectively).

CONCLUSIONS

Postoperative wound drain did not significantly reduce the incidence of an extradural hematoma after anterior circulation aneurysm surgery. On the contrary, it may be associated with an increased incidence of postoperative meningitis and length of stay. Given these findings, the postoperative drain should be maintained cautiously and meet more rigorous application criteria.

"Enhanced recovery after surgery - ERAS in elective craniotomies-a non-randomized controlled trial"

BACKGROUND

Enhanced Recovery After Surgery (ERAS) is a multimodal perioperative care bundle aimed at the early recovery of patients. Well accepted in gastric and pelvic surgeries, there is minimal evidence in neurosurgery and neurocritical care barring spinal surgeries. We wished to compare the length of intensive care unit (ICU) or high dependency unit (HDU) stay of patients undergoing elective craniotomy for supratentorial neurosurgery: ERAS protocol versus routine care. The secondary objective was to compare the postoperative pain scores, opioid use, glycemic control, and the duration of postoperative hospital stay between the two groups.

METHODS

In this pragmatic non-randomized controlled trial (CTRI/2017/07/015451), consenting adult patients scheduled for elective supratentorial intracranial tumor excision were enrolled prospectively after institutional ethical clearance and consent. Elements-of-care in the ERAS group were- Preoperative -family education, complex-carbohydrate drink, flupiritine; Intraoperative - scalp blocks, limited opioids, rigorous fluid and temperature regulation; Postoperative- flupiritine, early mobilization, removal of catheters, and initiation of feeds. Apart from these, all perioperative protocols and management strategies were similar between groups. The two groups were compared with regards to the length of ICU stay, pain scores in ICU, opioid requirement, glycemic control, and hospital stay duration. The decision for discharge from ICU and hospital, data collection, and analysis was by independent assessors blind to the patient group.

RESULTS

Seventy patients were enrolled. Baseline demographics - age, sex, tumor volume, and comorbidities were comparable between the groups. The proportion of patients staying in the ICU for less than 48 h after surgery, the cumulative insulin requirement, and the episodes of VAS scores > 4 in the first 48 h after surgery was significantly less in the ERAS group - 40.6% vs. 65.7%, 0.6 (±2.5) units vs. 3.6 (±8.1) units, and one vs. ten episodes (p = 0.04, 0.001, 0.004 respectively). The total hospital stay was similar in both groups.

CONCLUSION

The study demonstrated a significant reduction in the proportion of patients requiring ICU/ HDU stay > 48 h. Better pain and glycemic control in the postoperative period may have contributed to a decreased stay. More extensive randomized studies may be designed to confirm these results.

TRIAL REGISTRATION

Clinical Trial Registry of India ( CTRI/2018/04/013247 ), registered retrospectively on April 2018.