The evolving neurosurgical perspective on Enhanced Recovery After Surgery (ERAS): a systematic review

INTRODUCTION: Enhanced recovery after surgery (ERAS) programs may be implemented to minimize the body's stress response to surgery and enable a safe and timely discharge. Successful implementation involves a multifaceted approach from surgeons, anesthesiologists, nurses, nutritionists, and nonclinical staff. EVIDENCE ACQUISITION: National databases (MEDLINE (PubMed), Cochrane Central, and Google Scholar databases) were searched to identify studies on the clinical implementation of ERAS protocols in neurosurgery. A systematic review was chosen to select studies and pooled data analysis was performed. EVIDENCE SYNTHESIS: Thirty-five studies reported the use of enhanced recovery after surgery (ERAS), with 13 studies on cranial surgery and 22 on spinal surgery. Overall, 27 studies reported length of stay, 10 studies reported differences in opioid use, 21 studies reported either complications, readmission rate, or long term (>30 day) follow-up, 14 studies reported patient feedback, and 10 studies reported cost reduction of ERAS implementation. Findings supported significant reduction in length of stay, opioid use, and costs associated with ERAS regimens. Complications, readmission rates, and follow-up pain scores remained similar in ERAS and control groups. CONCLUSIONS: Our review finds that ERAS regimen implementation can serve an important role in facilitating clinical quality improvement and cost-effective care in all applications related to neurosurgical care and recovery. While application of ERAS in neurological surgery may have an important role in facilitating patient beneficial and cost-effective care, the findings of this review confirm that several challenges remain in select settings and prevent widespread implementation.