Enhanced Recovery After Surgery (ERAS) Protocols in Elective Craniotomy: A Systematic Review

Objective: To evaluate the efficacy and safety of Enhanced Recovery After Surgery (ERAS) protocols in adult patients undergoing elective craniotomy.Methods: A systematic review was conducted following PRISMA guidelines. Randomized controlled trials (RCTs) and observational studies with control groups were included. Databases searched included PubMed, Embase, Scopus, Web of Science, and Cochrane Library up to August 2023. Outcomes assessed were length of stay (LOS), postoperative complications, pain, PONV, and functional recovery. Risk of bias was evaluated using RoB 2 and ROBINS-I tools.Results: Ten studies (3 RCTs and 7 observational) were included. ERAS protocols were consistently associated with shorter hospital stays (1–2 days on average), improved postoperative pain control, and reduced PONV. No increase in complication rates was observed. Risk of bias was low in one RCT, moderate in one, and high in another. Observational studies presented moderate to high risk.Conclusions: ERAS protocols in elective craniotomy are effective and safe. Standardization and further high-quality multicenter RCTs are recommended.