Enhanced recovery after brain tumor surgery: pilot protocol implementation in a large healthcare system.

Publication Title

Neurosurgical focus [electronic resource]

Authors

Walavan Sivakumar, Department of Neurosurgery, Pacific Neuroscience Institute, Santa Monica, California, United States.Follow
Jian Guan, Pacific Neuroscience Institute Torrance, California.Follow
Jean-Philippe Langevin, Department of Neurosurgery, Pacific Neuroscience Institute, Santa Monica, CaliforniaFollow
Garni Barkhoudarian, Saint John's Cancer Institute, Providence Saint John's Health Center, Santa Monica, California, USA.Follow
Daniel F Kelly, Pacific Neuroscience Institute, Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USAFollow
Neil A Martin, Pacific Neuroscience Institute, Providence St John's Health Center, Santa Monica, CA, United StatesFollow

Document Type

Article

Publication Date

12-1-2023

Keywords

california; pni; sjci; pacific neuroscience; Humans; Pilot Projects; Enhanced Recovery After Surgery; Elective Surgical Procedures; Delivery of Health Care; Brain Neoplasms; Length of Stay; Postoperative Complications

Abstract

OBJECTIVE: Enhanced recovery after surgery (ERAS) protocols have been used in numerous specialties to improve the safety, efficiency, and cost of surgical interventions. Despite these successes, implementation of ERAS in cranial neurosurgery remains limited. In this study, a comprehensive ERAS protocol was implemented at two pilot sites within the Providence Health & Services system, and groundwork was laid for systemwide adoption.

METHODS: An enhanced recovery protocol was developed and implemented through an interdisciplinary team of clinicians, executive leadership, and clinical informatics professionals across preoperative, intraoperative, and postoperative domains. Outcomes including length of stay, discharge destination, and cost were collected through systemwide databases and compared with nonprotocolized sites.

RESULTS: During the study period, both pilot sites became top performers across the regional system in all evaluated metrics. The median length of stay for elective craniotomy at site 1 was reduced to 1.25 days, with a home discharge rate of > 90%. The cost per case at the pilot sites was nearly $7000 less on average than that of the nonprotocolized sites.

CONCLUSIONS: Implementation of enhanced recovery protocols for brain tumor surgery is feasible and effective, resulting in marked improvements in healthcare efficiency. Future studies, including implementation of the current protocol across the entire Providence system, are needed to maximize the potential benefits of enhanced recovery programs.

Clinical Institute

Cancer

Clinical Institute

Neurosciences (Brain & Spine)

Specialty/Research Institute

Neurosciences

Specialty/Research Institute

Oncology

Specialty/Research Institute

Surgery

DOI

10.3171/2023.9.FOCUS23563