Enhanced Recovery After Craniotomy: Global Practices, Challenges, and Perspectives

Anne Di Donato¹, Carlos Velásquez², Caroline Larkin³, Dana Baron Shahaf⁴, Eduardo Hernandez Bernal⁵, Faraz Shafiq⁶, Francis Kalipinde⁷, Fredson F Mwiga⁸, Geraldine Raphaela B Jose⁹, Kishore K Naidu Gangineni¹⁰, Kristof Nijs¹¹, Lapale Moipolai¹², Lashmi Venkatraghavan¹³, Lilian Lukoko¹⁴, Mihir Prakash Pandia¹⁵, Minyu Jian¹⁶, Naeema S Masohood¹⁷, Niels Juul¹⁸, Rafi Avitsian¹⁹, Nitin Manohara²⁰, Rajesha Srinivasaiah²¹, Riikka Takala²², Ritesh Lamsal²³, Saleh A Al Khunein²⁴, Sudadi Sudadi²⁵, Vladimir Cerny²⁶, Tumul Chowdhury¹³

Affiliations

¹ Department of Anesthesia, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
² Department of Neurological Surgery, Marqués de Valdecilla University Hospital, Santander, Spain.
³ Department of Anesthesia, Beaumont Hospital, Dublin, Ireland.
⁴ Department of Anesthesia, Rambam Health Care Campus, Haifa, Israel.
⁵ Department of Neuroanesthesia. Manuel Velasco Suárez National Institute of Neurology and Neurosurgery, Mexico City, Mexico.
⁶ Department of Anesthesia, The Aga Khan University, Karachi, Pakistan.
⁷ Department of Anesthesia, University Teaching Hospital, Lusaka, Zambia.
⁸ Department of Anesthesia, Kilimanjaro Christian Medical Center, Moshi, Tanzania.
⁹ Department of Anesthesia, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
¹⁰ Department of Neuroanesthesia at Hamad General Hospital, Doha, Qatar.
¹¹ Department of Anesthesia and Intensive Care Medicine, Jessa Hospital, Hasselt, Belgium.
¹² Department of Anesthesia, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.
¹³ Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada.
¹⁴ Department of Anesthesia, Aga Khan University Hospital, Nairobi, Kenya.
¹⁵ Department of Neuroanaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
¹⁶ Department of Anesthesia, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
¹⁷ Department of Anesthesia and Critical Care, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
¹⁸ Department of Anesthesia and Surgery, Aarhus University Hospital, Aarhus, Denmark.
¹⁹ Department of Anesthesia, Cleveland Clinic, Cleveland, OH.
²⁰ Department of Anesthesia and Critical Care, Anaesthesia Institute, Cleveland Clinic Abu Dhabi, UAE.
²¹ Department of Neuro Anaesthesia, The Walton Centre, Liverpool, UK.
²² Department of Anesthesia and Intensive Care Medicine, Perioperative Services, Intensive Care Medicine and Pain Management Turku University Hospital, University of Turku, Turku, Finland.
²³ Department of Anesthesia, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
²⁴ Department of Anesthesia, Prince Sultan Military Medical City, Saudi Anaesthesia Scientific Council, Riyadh, Saudi Arabia.
²⁵ Department of Anesthesia, Universitas Gadjah Mada, Yogyakarta, Indonesia.
²⁶ Department of Anesthesia and Intensive Care Medicine, Charles University in Prague, 3rd Faculty of Medicine, Prague, Czech Republic.

PMID: 39494915
DOI: 10.1097/ANA.0000000000001011

Review

Enhanced Recovery After Craniotomy: Global Practices, Challenges, and Perspectives

Anne Di Donato et al. J Neurosurg Anesthesiol. 2025.

. 2025 Jul 1;37(3):255-264.

doi: 10.1097/ANA.0000000000001011. Epub 2024 Nov 4.

Authors

Affiliations

¹ Department of Anesthesia, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
² Department of Neurological Surgery, Marqués de Valdecilla University Hospital, Santander, Spain.
³ Department of Anesthesia, Beaumont Hospital, Dublin, Ireland.
⁴ Department of Anesthesia, Rambam Health Care Campus, Haifa, Israel.
⁵ Department of Neuroanesthesia. Manuel Velasco Suárez National Institute of Neurology and Neurosurgery, Mexico City, Mexico.
⁶ Department of Anesthesia, The Aga Khan University, Karachi, Pakistan.
⁷ Department of Anesthesia, University Teaching Hospital, Lusaka, Zambia.
⁸ Department of Anesthesia, Kilimanjaro Christian Medical Center, Moshi, Tanzania.
⁹ Department of Anesthesia, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
¹⁰ Department of Neuroanesthesia at Hamad General Hospital, Doha, Qatar.
¹¹ Department of Anesthesia and Intensive Care Medicine, Jessa Hospital, Hasselt, Belgium.
¹² Department of Anesthesia, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.
¹³ Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada.
¹⁴ Department of Anesthesia, Aga Khan University Hospital, Nairobi, Kenya.
¹⁵ Department of Neuroanaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
¹⁶ Department of Anesthesia, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
¹⁷ Department of Anesthesia and Critical Care, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
¹⁸ Department of Anesthesia and Surgery, Aarhus University Hospital, Aarhus, Denmark.
¹⁹ Department of Anesthesia, Cleveland Clinic, Cleveland, OH.
²⁰ Department of Anesthesia and Critical Care, Anaesthesia Institute, Cleveland Clinic Abu Dhabi, UAE.
²¹ Department of Neuro Anaesthesia, The Walton Centre, Liverpool, UK.
²² Department of Anesthesia and Intensive Care Medicine, Perioperative Services, Intensive Care Medicine and Pain Management Turku University Hospital, University of Turku, Turku, Finland.
²³ Department of Anesthesia, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
²⁴ Department of Anesthesia, Prince Sultan Military Medical City, Saudi Anaesthesia Scientific Council, Riyadh, Saudi Arabia.
²⁵ Department of Anesthesia, Universitas Gadjah Mada, Yogyakarta, Indonesia.
²⁶ Department of Anesthesia and Intensive Care Medicine, Charles University in Prague, 3rd Faculty of Medicine, Prague, Czech Republic.

PMID: 39494915
DOI: 10.1097/ANA.0000000000001011

Abstract

The global demand for hospital care, driven by population growth and medical advances, emphasizes the importance of optimized resource management. Enhanced Recovery After Surgery (ERAS) protocols aim to expedite patient recovery and reduce health care costs without compromising patient safety or satisfaction. Its principles have been adopted in various surgical specialties but have not fully encompassed all areas of neurosurgery, including craniotomy. ERAS for craniotomy has been shown to reduce the length of hospital stay and costs without increasing complications. ERAS protocols may also reduce postoperative nausea and vomiting and perioperative opioid requirements, highlighting their potential to enhance patient outcomes and health care efficiency. Despite these benefits, guidelines, and strategies for ERAS in craniotomy remain limited. This narrative review explores the current global landscape of ERAS for craniotomy, assessing existing literature and highlighting knowledge gaps. Experts from 26 countries with diverse cultural and socioeconomic backgrounds contributed to this review, offering insights about current ERAS protocol applications, implementation challenges, and future perspectives, and providing a comprehensive global overview of ERAS for craniotomy. Representatives from all 6 World Health Organization geographical world areas reported that barriers to the implementation of ERAS for craniotomy include the absence of standardized protocols, provider resistance to change, resource constraints, insufficient education, and research scarcity. This review emphasizes the necessity of tailored ERAS protocols for low and middle-income countries, addressing differences in available resources. Acknowledging limitations in subjectivity and article selection, this review provides a comprehensive overview of ERAS for craniotomy from a global perspective and underscores the need for adaptable ERAS protocols tailored to specific health care systems and countries.

Keywords: ERAS for craniotomy; ERAS global perspective; enhanced recovery in craniotomy; hospital cost reduction; hospital length of stay.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

References

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Enhanced Recovery After Craniotomy: Global Practices, Challenges, and Perspectives

Affiliations

Enhanced Recovery After Craniotomy: Global Practices, Challenges, and Perspectives

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources