{"product_id":"enhanced-recovery-after-surgery-eras-vs-standard-care-for-brain-tumor-surgery-what-patients-need-to-know","title":"Enhanced Recovery After Surgery (ERAS) vs. Standard Care for Brain Tumor Surgery: What Patients Need to Know","description":"\u003cp\u003eThis comprehensive review compares Enhanced Recovery After Surgery (ERAS) protocols with standard postoperative care in patients undergoing elective craniotomy for brain tumor removal. The review found that ERAS protocols are associated with reduced postoperative nausea and vomiting. In one cohort, postoperative nausea and vomiting fell from roughly 28.0% to 9.2%. The review found improved functional status, with a pooled mean difference of 6.68 points on the Karnofsky Performance Status scale. The review found higher patient satisfaction, at 92.2% versus 86.8%. The review found ICU stays reduced to under one day. The review found per-patient cost savings of $1,044 to $4,026. However, implementation remains uneven, particularly in low- and middle-income countries, and no ERAS Society guideline yet exists for cranial neurosurgery.\u003c\/p\u003e\n\n\u003ch1\u003eEnhanced Recovery After Surgery (ERAS) vs. Standard Care for Brain Tumor Surgery: What Patients Need to Know\u003c\/h1\u003e\n\n\u003ch2\u003eTable of Contents\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003e\u003ca href=\"#ddn-key-points\"\u003eKey Points\u003c\/a\u003e\u003c\/li\u003e\n\n\u003cli\u003e\u003ca href=\"#background\"\u003eBackground: Why This Research Matters\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#methods\"\u003eHow the Research Was Conducted\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#standard-protocol\"\u003eStandard Postoperative Care After Craniotomy\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#eras-protocol\"\u003eThe ERAS Protocol for Craniotomy\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#anesthesia\"\u003eAnesthetic Protocol Differences and Perioperative Considerations\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#preoperative\"\u003ePreoperative Risk Assessment and Optimization\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#key-findings\"\u003eKey Findings: Clinical Outcomes\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#implementation\"\u003eImplementation Challenges and Workflow Barriers\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#limitations\"\u003eLimitations of This Review\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#recommendations\"\u003eRecommendations for Patients\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#ddn-faq\"\u003eFrequently Asked Questions\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#source\"\u003eSource Information\u003c\/a\u003e\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003c!-- ddn:keypoints:start --\u003e\n\u003ch2 id=\"ddn-key-points\"\u003eKey Points\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003eERAS is a coordinated approach that may reduce nausea and vomiting, improve functional status, raise satisfaction, shorten ICU stays, and lower costs compared with standard care after elective craniotomy.\u003c\/li\u003e\n\u003cli\u003eIn one cohort, postoperative nausea and vomiting fell from roughly 28.0% to 9.2% with ERAS; a pooled mean difference of 6.68 points on the Karnofsky scale came from a cited meta-analysis.\u003c\/li\u003e\n\u003cli\u003eA 2025 review of 7 studies (2,251 patients) found no significant difference in bleeding complications between NSAID and non-NSAID regimens, supporting selective NSAID use once hemostasis is confirmed.\u003c\/li\u003e\n\u003cli\u003eImplementation of ERAS for craniotomy remains uneven, especially in low- and middle-income countries, and no ERAS Society guideline yet exists for cranial neurosurgery.\u003c\/li\u003e\n\u003cli\u003eThis is a narrative review, not a systematic review; findings are reported descriptively as the range and direction of effects, without formal risk-of-bias assessment or pooled estimates unless cited.\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003c!-- ddn:keypoints:end --\u003e\n\n\n\u003ch2 id=\"background\"\u003eBackground: Why This Research Matters\u003c\/h2\u003e\n\n\u003cp\u003eElective craniotomy (planned surgical opening of the skull) is a common neurosurgical procedure. Surgeons perform this operation for brain tumors, vascular malformations (abnormal blood vessels), epilepsy, and other intracranial abnormalities (problems inside the skull). Recovery after this surgery is often prolonged. Patients face pain, nausea, neurological deficits (problems with brain function), and delayed mobilization (getting out of bed and moving). These issues can lead to longer hospital stays and higher rates of complications.\u003c\/p\u003e\n\n\u003cp\u003eStandard postoperative care varies widely between hospitals. It often lacks a structured, multidisciplinary framework (a coordinated approach involving multiple specialists). This variation may affect both the quality and duration of recovery.\u003c\/p\u003e\n\n\u003cp\u003eIn 1997, a researcher named Kehlet introduced the multimodal (fast-track) rehabilitation concept that underlies Enhanced Recovery After Surgery (ERAS). The goal was to reduce complications, improve outcomes, and lower healthcare costs. The pathophysiological rationale (the scientific reasons behind the approach) was elaborated by Kehlet and Wilmore in 2002. The ERAS Society was founded in 2010, building on a first colorectal guideline published in 2005. Since then, the Society has endorsed guidelines for liver, gastric, esophageal, bariatric, head and neck, and breast reconstruction surgeries.\u003c\/p\u003e\n\n\u003cp\u003eMeta-analytic evidence (combined results from many studies) across specialties consistently demonstrates fewer complications, faster recovery, shorter hospital stays, and improved patient experience with ERAS. However, introducing ERAS to neurosurgery presents unique challenges. The brain is complex, and patients need careful neurological monitoring. Formal cranial uptake (adoption of ERAS for skull surgeries) has trailed colorectal and gastric ERAS by roughly a decade. The earliest craniotomy-specific ERAS cohorts were reported from approximately 2017 onward.\u003c\/p\u003e\n\n\u003cp\u003eEarly studies suggest ERAS can be safely and effectively applied in elective craniotomy. These protocols typically include preoperative counseling, short fasting, optimized pain and nausea control, reduced use of drains and catheters, early physiotherapy, and a clear discharge and rehabilitation plan. Despite an expanding body of single-study evidence and several prior systematic reviews and meta-analyses on this question, no ERAS Society guideline yet exists for cranial neurosurgery. The implementation, workflow, and economic dimensions of cranial ERAS adoption — particularly in low- and middle-income settings — remain comparatively unsynthesized. This review aims to fill that gap alongside summarizing the clinical outcomes evidence.\u003c\/p\u003e\n\n\u003cp\u003eThis narrative review compares ERAS protocols with standard postoperative care in elective craniotomy for brain tumor excision. It evaluates outcomes such as hospital length of stay (LOS), complication rates, pain management, and overall recovery. It also examines the implementation challenges, workflow barriers, and economic and equity considerations that shape real-world adoption. The goal is to support safer, faster, and more patient-centered recovery pathways in neurosurgery.\u003c\/p\u003e\n\n\u003ch2 id=\"methods\"\u003eHow the Research Was Conducted\u003c\/h2\u003e\n\n\u003cp\u003eThis is a narrative review, reported according to the Scale for the Assessment of Narrative Review Articles (SANRA) rather than a systematic-review checklist. No meta-analysis or formal risk-of-bias assessment of individual studies was performed.\u003c\/p\u003e\n\n\u003cp\u003eResearchers searched PubMed\/MEDLINE, Embase, Scopus, and Google Scholar from database inception through June 2026. They used combinations of the terms \"enhanced recovery after surgery,\" \"ERAS,\" \"fast-track,\" \"craniotomy,\" \"brain tumor,\" \"neurosurgery,\" and \"perioperative care.\" Reference lists of retrieved systematic reviews and meta-analyses were hand-searched. The hand-search looked for additional eligible studies.\u003c\/p\u003e\n\n\u003cp\u003eEligible sources included randomized controlled trials, prospective and retrospective cohort studies, and systematic reviews\/meta-analyses. All sources were in English and addressed perioperative (ERAS or standard) care in adult patients undergoing elective craniotomy. Case reports, non-peer-reviewed sources, and studies restricted to non-cranial procedures were excluded unless cited for background context only.\u003c\/p\u003e\n\n\u003cp\u003eBecause this is a narrative synthesis, quantitative findings drawn from individual primary studies are reported descriptively. They are presented as the range and direction of effects found in the literature. They are not pooled or meta-analytic estimates unless explicitly identified as coming from a cited meta-analysis.\u003c\/p\u003e\n\n\u003ch2 id=\"standard-protocol\"\u003eStandard Postoperative Care After Craniotomy\u003c\/h2\u003e\n\n\u003cp\u003eUnderstanding the stepwise process for elective craniotomy helps provide context for which preoperative and postoperative procedures are standardized and practiced by different institutes. Standardized protocols for elective craniotomy consist of the same general steps.\u003c\/p\u003e\n\n\u003cp\u003eCraniotomy for tumor resection usually consists of several standardized steps. After diagnosis through imaging, neurological exam, or biopsy, patients are prepared preoperatively with IV access, antibiotics, anesthesia, and catheterization. The scalp is shaved, disinfected, and incised to expose the skull, which is opened with a craniotome (a specialized surgical drill). Then, the dura (the protective membrane covering the brain) is incised to access the brain. Tumor resection is performed, often aided by stereotactic navigation and imaging guidance for precision. Finally, the dura is sutured, the bone flap is replaced (cranioplasty), soft tissues are closed in layers, and the patient is gradually awakened from anesthesia.\u003c\/p\u003e\n\n\u003cp\u003eStandard postoperative care following elective craniotomy traditionally includes close monitoring in an ICU setting. Standard postoperative care also includes use of opioid-based analgesia (pain relief using morphine-like drugs). Standard postoperative care also includes delayed initiation of oral intake. Standard postoperative care also includes prolonged bed rest. These practices may contribute to a longer recovery period. These practices may contribute to a higher risk of complications such as infections or deep vein thrombosis (DVT, blood clots in deep veins). These practices may contribute to lower patient satisfaction.\u003c\/p\u003e\n\n\u003cp\u003eInstitutional and procedural examples of this process, drawn from published series, include awake craniotomy for gliomas at centers such as MD Anderson Cancer Center. Institutional and procedural examples also include various resection approaches for meningiomas at institutions including Mayo Clinic Rochester and Cleveland Clinic Florida. Outpatient craniotomy for intra-axial tumors has been performed at Toronto Western Hospital. These examples illustrate the range of standard approaches across different tumor types and institutions.\u003c\/p\u003e\n\n\u003ch2 id=\"eras-protocol\"\u003eThe ERAS Protocol for Craniotomy\u003c\/h2\u003e\n\n\u003cp\u003eERAS craniotomy protocols for tumor resection are widely varied. They begin with preoperative counseling and comorbidity\/risk factor assessment that impacts recovery.\u003c\/p\u003e\n\n\u003cp\u003eThe Non-Intensive Care (NICE) protocol, developed at Stanford University Medical Center, focuses on preoperative optimization of recovery. It modifies craniotomy eligibility screening metrics to assess the likelihood of several postoperative events:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003eCardiopulmonary resuscitation (CPR) in the intensive care unit (ICU)\u003c\/li\u003e\n\u003cli\u003eNeed for intubation (breathing tube placement)\u003c\/li\u003e\n\u003cli\u003eReturn to the operating room (OR) within 24 hours\u003c\/li\u003e\n\u003cli\u003eMechanical ventilation exceeding four hours\u003c\/li\u003e\n\u003cli\u003eIntravenous (IV) vasopressor requirements exceeding 0.4 mg per hour\u003c\/li\u003e\n\u003cli\u003eIntracranial hypertension (HTN, high pressure inside the skull) requiring cerebrospinal fluid (CSF) drainage and mannitol\u003c\/li\u003e\n\u003cli\u003eDysphagia (difficulty swallowing) requiring gastrostomy tube (G-tube) nutrition\u003c\/li\u003e\n\u003cli\u003eDeath within 48 hours of surgery\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eThese risks are calculated based on prognostic features. These features include age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, Glasgow Coma Scale (GCS) score, and neurological screening findings. These features also include chronic diseases (diabetes mellitus, hypertension, clotting disorders, and seizure disorders). These features also include neurosurgical history, anticoagulation use, cardiovascular disease (CVD), and pulmonary disease. Tumor characteristics identified through diagnostic imaging also influence prognosis and eligibility according to the NICE protocol.\u003c\/p\u003e\n\n\u003cp\u003eDifferent centers may adopt varying protocols. These include wound care, drain care, neurocritical care, reversal of coagulopathy (clotting problems), DVT prevention, discharge measures, and, in ERAS protocols, early mobilization.\u003c\/p\u003e\n\n\u003cp\u003ePublished neurosurgical ERAS recommendations include:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003eLesion-specific preoperative counseling\u003c\/li\u003e\n\u003cli\u003eSmoking and alcohol cessation for 30 days before surgery (with possible pharmacological or counseling support)\u003c\/li\u003e\n\u003cli\u003eOptimized nutrition, such as enteral feeding and carbohydrate-rich clear fluids before the operation\u003c\/li\u003e\n\u003cli\u003eInfection prevention measures including IV cefazolin administration before incision, with vancomycin recommended for patients with a history of methicillin-resistant Staphylococcus aureus (MRSA)\u003c\/li\u003e\n\u003cli\u003eStress reduction, anxiety and pain management, and prehabilitation (preoperative exercise)\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eIntraoperatively, ERAS emphasizes reduced fluid administration with vasopressors to manage blood flow. This contrasts with higher volumes under standard care. Nutrition protocols include preoperative protein and micronutrient support, electrolyte drinks before surgery, and early postoperative feeding beginning with liquids six hours after surgery.\u003c\/p\u003e\n\n\u003cp\u003ePostoperative ERAS pain management prioritizes non-opioid analgesia. It uses agents such as gabapentin, celecoxib, and acetaminophen, along with nonsteroidal anti-inflammatory drugs (NSAIDs) and local nerve blocks. These agents are not associated with high rates of tolerance and dependence as narcotics like morphine or fentanyl. Postoperative care also includes neurological assessment, extubation (removal of the breathing tube), early ambulation, and nausea control. Postoperative care also includes early removal of Foley catheters and IV lines, wound care instruction, and occupational\/palliative care support.\u003c\/p\u003e\n\n\u003ch2 id=\"anesthesia\"\u003eAnesthetic Protocol Differences and Perioperative Considerations\u003c\/h2\u003e\n\n\u003cp\u003eAppropriate patient selection, thorough neurological and preanesthetic assessment, and an individualized anesthesia plan enhance recovery and decrease hospital length of stay (LOS). Preoperative measures such as counseling, nutrition, antithrombotic medications (antiplatelets\/anticoagulants), reversal agents (vitamin K, 4F-PCC, platelet transfusion), and antimicrobial prophylaxis are equally important.\u003c\/p\u003e\n\n\u003cp\u003eIntraoperative strategies include scalp infiltration, anesthetic protocol, analgesics, fluid maintenance, core temperature management, and minimally invasive tumor access to reduce complications. EEG monitoring may be limited near the surgical site, so clinical sedation assessment is more accurate.\u003c\/p\u003e\n\n\u003cp\u003eAcute postoperative pain is managed with magnesium sulfate, dexmedetomidine, lidocaine, acetaminophen, opioids, or gabapentin. Dexmedetomidine-based anesthesia with scalp block is increasingly used to avoid airway intervention.\u003c\/p\u003e\n\n\u003cp\u003ePostoperative care includes managing nausea and vomiting with serotonin receptor antagonists, dexamethasone, scopolamine, and acupoint stimulation. These may also provide neuroprotective effects. Early nutrition and ambulation, along with reduction of postoperative nausea and vomiting (PONV), support faster recovery and fewer complications.\u003c\/p\u003e\n\n\u003cp\u003eNeuroanesthesia principles focus on optimizing operative conditions and maintaining cerebral perfusion pressure (CPP) and oxygenation. Agents such as propofol reduce intracranial pressure (ICP), dexamethasone reduces pain and swelling, and sevoflurane or total intravenous anesthesia (TIVA) with propofol\/remifentanil facilitate faster recovery. ERAS anesthetic methods differ in sedation depth, agent selection, and airway support.\u003c\/p\u003e\n\n\u003cp\u003eOpioid-free anesthesia protocols using dexmedetomidine, propofol, rocuronium, lidocaine, scalp block, dexamethasone, and mannitol provide stable hemodynamics, sufficient analgesia, reduced nausea and vomiting, and immediate postoperative extubation.\u003c\/p\u003e\n\n\u003cp\u003eFor awake craniotomy, monitored anesthesia care (MAC) with IV dexmedetomidine, remifentanil, and propofol allows intraoperative arousal for brain mapping and tumor resection. The asleep-awake-asleep (AAA) technique uses propofol, remifentanil, and local anesthesia (elliptic block with lidocaine and bupivacaine) to facilitate seamless transitions between sedation and wakefulness. Both approaches improve outcomes and reduce functional complications compared with general anesthesia.\u003c\/p\u003e\n\n\u003cp\u003eConcerns about increased bleeding risk have made some neurosurgeons reluctant to use NSAIDs as part of multimodal analgesia after craniotomy. A 2025 systematic review and meta-analysis of 7 studies (2,251 patients) found no significant differences in overall bleeding complications (risk ratio 1.05) between NSAID and non-NSAID analgesic regimens. The review found no significant differences in bleeding complications requiring reoperation (risk ratio 1.27) between NSAID and non-NSAID analgesic regimens. This supports selective NSAID use as a reasonable component of opioid-sparing analgesia once hemostasis and coagulation status have been confirmed intraoperatively. It is not a blanket substitute for opioids in all patients.\u003c\/p\u003e\n\n\u003cp\u003eRegarding seizure prophylaxis, current guidance does not support routine prophylactic anticonvulsants in seizure-naive patients undergoing elective craniotomy for brain tumors. A joint Society for Neuro-Oncology\/European Association of Neuro-Oncology update reaches this conclusion. A Cochrane review also reaches this conclusion. Both conclude that prophylaxis should be reserved for patients with a seizure history or specific risk factors. Prophylaxis should not be applied universally. This is consistent with ERAS's broader preference for minimizing unnecessary pharmacologic burden.\u003c\/p\u003e\n\n\u003ch2 id=\"preoperative\"\u003ePreoperative Risk Assessment and Optimization\u003c\/h2\u003e\n\n\u003cp\u003eExtensive preoperative assessment is crucial for clinical outcomes and recovery and is a key part of ERAS protocols. Certain risk factors can significantly affect outcomes in elective craniotomy for brain tumor resection.\u003c\/p\u003e\n\n\u003ch3\u003eFrailty Assessment\u003c\/h3\u003e\n\n\u003cp\u003eFormal frailty scoring is not yet incorporated into a published cranial ERAS protocol in the way the Caprini score is used for VTE. Frailty tools reported in the neuro-oncologic surgery literature include the 5-item modified frailty index (mFI-5) and the Clinical Frailty Scale. In a cohort of brain tumor patients, each one-point increase in mFI-5 was associated with longer ICU and total hospital LOS and higher odds of non-home discharge. Incorporating a validated frailty score into preoperative ERAS risk stratification, alongside the Caprini score, is a reasonable near-term step. This represents a current gap in the literature rather than an established component of any published protocol.\u003c\/p\u003e\n\n\u003ch3\u003eDeep Vein Thrombosis\u003c\/h3\u003e\n\n\u003cp\u003eSymptomatic DVT after craniotomy occurs in roughly 1%-10% of patients. Screening-detected (subclinical) DVT on routine duplex ultrasound can approach 30%-50%, depending on the detection method and timing. Both are driven by prolonged immobilization, tumor-induced hypercoagulability (increased tendency to form blood clots), and operative time.\u003c\/p\u003e\n\n\u003cp\u003eERAS protocols recommend preoperative VTE risk assessment using tools such as the Caprini score to inform prophylaxis strategies. Prevention measures include intraoperative and postoperative intermittent pneumatic compression and pharmacological agents, with strict timelines under ERAS protocols compared with standard care.\u003c\/p\u003e\n\n\u003cp\u003eTotal Caprini scores map onto four standard risk tiers with corresponding prophylaxis recommendations:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003e\n\u003cstrong\u003eVery low risk (0-1 point):\u003c\/strong\u003e early ambulation alone\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eLow risk (2 points):\u003c\/strong\u003e mechanical prophylaxis\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eModerate risk (3-4 points):\u003c\/strong\u003e mechanical prophylaxis with consideration of pharmacologic prophylaxis once hemostasis is confirmed\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eHigh risk (≥5 points):\u003c\/strong\u003e combined mechanical and pharmacologic prophylaxis\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eThese tiers reflect a graded increase in symptomatic VTE incidence across tiers. The Caprini score assigns points for various risk factors. These include age 40-59 years (1 point), BMI ≥ 30 kg\/m² (1 point), history of prior major surgery within 1 month (1 point), swollen legs (1 point), varicose veins (1 point), and sepsis within 1 month (1 point). These include abnormal pulmonary function\/COPD (1 point), acute myocardial infarction within 1 month (1 point), congestive heart failure within 1 month (1 point), and history of inflammatory bowel disease (1 point). These include medical patient at bed rest (1 point), pregnant or post-partum (1 point), history of unexplained or recurrent spontaneous abortion (1 point), and oral contraceptives or hormone replacement therapy (1 point). These include age 60-74 years (2 points), arthroscopic surgery (2 points), major open surgery over 45 minutes (2 points), and laparoscopic surgery over 45 minutes (2 points). These include prior cancer except non-melanoma skin cancer (2 points), present cancer except breast and thyroid (2 points), confined to bed over 72 hours (2 points), and immobilizing plaster cast (2 points). These include central venous access (2 points), age ≥ 75 years (3 points), history of VTE (3 points), and family history of VTE (3 points). These include present chemotherapy (3 points), positive Factor V Leiden (3 points), positive Prothrombin 20210A (3 points), and positive Lupus anticoagulant (3 points). These include elevated anticardiolipin antibodies (3 points), elevated serum homocysteine (3 points), heparin-induced thrombocytopenia (3 points), and other congenital or acquired thrombophilias (3 points). These include major surgery lasting over 6 hours (5 points), stroke within 1 month (5 points), and elective major lower extremity arthroplasty (5 points). These include hip\/pelvis\/leg fracture within 1 month (5 points), acute spinal cord fracture or paralysis within 1 month (5 points), and multiple traumas within 1 month (5 points).\u003c\/p\u003e\n\n\u003ch3\u003eAspirin Usage\u003c\/h3\u003e\n\n\u003cp\u003eLimited studies describe the influence of aspirin and other antiplatelet medications before elective brain surgery. Hanaliouglu et al. found no direct correlation between aspirin usage and hemorrhagic complications. There were no significant differences in operative blood loss, hemorrhagic, or thromboembolic events among ASA users, those who stopped aspirin before surgery, and non-users. Other studies similarly concluded that aspirin can be safely continued in patients with high cardiovascular risk before craniotomy. Decisions regarding its use are based on tumor type and comorbidities.\u003c\/p\u003e\n\n\u003ch3\u003eHyperglycemia\u003c\/h3\u003e\n\n\u003cp\u003ePreoperative risk assessment for hyperglycemia (high blood sugar) is important due to complications such as blood-brain barrier dysfunction, cerebral edema, tumor growth, and postoperative infections. ERAS protocols recommend screening all patients, including those without a prior diabetes diagnosis.\u003c\/p\u003e\n\n\u003ch2 id=\"key-findings\"\u003eKey Findings: Clinical Outcomes\u003c\/h2\u003e\n\n\u003cp\u003eAcross the literature reviewed, ERAS is associated with concrete gains over standard care. These findings represent the range and direction of effects found in individual studies, not pooled meta-analytic estimates unless explicitly identified.\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003e\n\u003cstrong\u003ePostoperative nausea and vomiting:\u003c\/strong\u003e Falling from roughly 28.0% to 9.2% in one cohort\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eKarnofsky Performance Status:\u003c\/strong\u003e An improvement of approximately 10 points sustained at 30 days (pooled mean difference 6.68 points)\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003ePatient satisfaction:\u003c\/strong\u003e 92.2% versus 86.8%\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eICU length of stay:\u003c\/strong\u003e Reduced to under one day\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003ePer-patient cost reductions:\u003c\/strong\u003e $1,044 to $4,026\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eThe Karnofsky Performance Status is a scale that measures a patient's ability to perform ordinary tasks. A 10-point improvement represents a meaningful gain in functional independence. The pooled mean difference of 6.68 points comes from a cited meta-analysis.\u003c\/p\u003e\n\n\u003cp\u003eThese outcomes suggest that ERAS protocols can help patients recover more efficiently. Reduced nausea and vomiting means patients can eat sooner and feel better. Improved functional status means patients can return to daily activities faster. Higher satisfaction means patients feel better cared for. Shorter ICU stays and lower costs mean healthcare resources are used more efficiently.\u003c\/p\u003e\n\n\u003ch2 id=\"implementation\"\u003eImplementation Challenges and Workflow Barriers\u003c\/h2\u003e\n\n\u003cp\u003eHospitals must undertake protocol development, arrange training, and ensure flexibility to adapt ERAS elements to each patient's clinical needs. Implementation remains uneven across economic and resource settings, particularly in low- and middle-income countries.\u003c\/p\u003e\n\n\u003cp\u003eSeveral factors contribute to these challenges. ERAS protocols require multidisciplinary coordination among surgeons, anesthesiologists, nurses, physiotherapists, and nutritionists. This coordination may be difficult to achieve in hospitals with limited staff or resources. Training programs are needed to educate healthcare providers about ERAS principles and techniques. Hospitals must also develop systems to track outcomes and ensure compliance with protocols.\u003c\/p\u003e\n\n\u003cp\u003eEconomic and equity considerations shape real-world adoption. In low- and middle-income countries, resource limitations may prevent the implementation of certain ERAS elements. For example, access to certain medications, monitoring equipment, or specialized personnel may be limited. Cultural and institutional factors may also influence adoption.\u003c\/p\u003e\n\n\u003cp\u003eAs interest in ERAS grows, further research and education will be essential to support wider and more effective practice across neurosurgical practices. The absence of an ERAS Society guideline for cranial neurosurgery means that protocols vary widely between institutions. This variation makes it difficult to compare outcomes across studies and to establish best practices.\u003c\/p\u003e\n\n\u003ch2 id=\"limitations\"\u003eLimitations of This Review\u003c\/h2\u003e\n\n\u003cp\u003eThis is a narrative review, not a systematic review. No meta-analysis or formal risk-of-bias assessment of individual studies was performed. Quantitative findings are reported descriptively as the range and direction of effects found in the literature. They are not pooled or meta-analytic estimates unless explicitly identified as coming from a cited meta-analysis.\u003c\/p\u003e\n\n\u003cp\u003eThe review included randomized controlled trials, prospective and retrospective cohort studies, and systematic reviews\/meta-analyses. Case reports and non-peer-reviewed sources were excluded. Studies restricted to non-cranial procedures were excluded unless cited for background context only.\u003c\/p\u003e\n\n\u003cp\u003eSeveral gaps in the literature were identified. Formal frailty scoring is not yet incorporated into a published cranial ERAS protocol. No ERAS Society guideline yet exists for cranial neurosurgery. The implementation, workflow, and economic dimensions of cranial ERAS adoption — particularly in low- and middle-income settings — remain comparatively unsynthesized.\u003c\/p\u003e\n\n\u003cp\u003eThe review did not perform a formal risk-of-bias assessment. This means the quality of individual studies was not systematically evaluated. The findings should be interpreted with this limitation in mind.\u003c\/p\u003e\n\n\u003ch2 id=\"recommendations\"\u003eRecommendations for Patients\u003c\/h2\u003e\n\n\u003cp\u003eIf you are scheduled for elective craniotomy for brain tumor removal, you may want to ask your surgical team whether they use ERAS protocols. Here are some questions to consider:\u003c\/p\u003e\n\n\u003col\u003e\n\u003cli\u003eDoes your hospital have an ERAS protocol for craniotomy? If so, what does it include?\u003c\/li\u003e\n\u003cli\u003eWill you receive preoperative counseling about nutrition, smoking cessation, and prehabilitation?\u003c\/li\u003e\n\u003cli\u003eWhat pain management approach will be used? Will non-opioid medications be prioritized?\u003c\/li\u003e\n\u003cli\u003eWhen will you be able to eat and drink after surgery?\u003c\/li\u003e\n\u003cli\u003eWhen will you be encouraged to get out of bed and move around?\u003c\/li\u003e\n\u003cli\u003eWhen will catheters and drains be removed?\u003c\/li\u003e\n\u003cli\u003eWhat is the expected length of your ICU and hospital stay?\u003c\/li\u003e\n\u003cli\u003eWhat is the plan for discharge and rehabilitation?\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003cp\u003eERAS protocols are designed to help you recover faster and with fewer complications. They include preoperative counseling, short fasting, optimized pain and nausea control, reduced use of drains and catheters, early physiotherapy, and a clear discharge and rehabilitation plan.\u003c\/p\u003e\n\n\u003cp\u003eIf your hospital does not use ERAS protocols, you can still discuss some of these elements with your care team. For example, you can ask about early mobilization, early oral intake, and non-opioid pain management options. These discussions may help you have a smoother recovery.\u003c\/p\u003e\n\n\u003cp\u003eIt is important to remember that ERAS protocols are not one-size-fits-all. Your surgical team will adapt the protocol to your specific clinical needs. Factors such as your age, overall health, tumor type, and comorbidities will influence your care plan.\u003c\/p\u003e\n\n\u003c!-- ddn:faq:start --\u003e\n\u003ch2 id=\"ddn-faq\"\u003eFrequently Asked Questions\u003c\/h2\u003e\n\u003ch3\u003eWhat is ERAS and how does it differ from standard care after brain tumor surgery?\u003c\/h3\u003e\n\u003cp\u003eERAS (Enhanced Recovery After Surgery) is a structured, coordinated approach designed to speed recovery. Standard care often includes ICU monitoring, opioid pain relief, delayed eating, and prolonged bed rest. ERAS instead emphasizes preoperative counseling, short fasting, non-opioid pain and nausea control, fewer drains and catheters, early physiotherapy, and a clear discharge plan.\u003c\/p\u003e\n\u003ch3\u003eWhat benefits have been linked to ERAS for craniotomy?\u003c\/h3\u003e\n\u003cp\u003eIn the reviewed literature, ERAS was associated with reduced postoperative nausea and vomiting (falling from roughly 28.0% to 9.2% in one cohort), improved functional status (pooled mean difference 6.68 points on the Karnofsky scale), higher patient satisfaction (92.2% versus 86.8%), ICU stays under one day, and per-patient cost savings of $1,044 to $4,026.\u003c\/p\u003e\n\u003ch3\u003eWill I be able to eat and drink sooner with ERAS?\u003c\/h3\u003e\n\u003cp\u003eERAS protocols typically include early postoperative feeding, often starting with liquids about six hours after surgery. Standard care traditionally delays oral intake. Earlier eating and drinking may help you feel better and recover faster, but your surgical team will adapt the timing to your specific clinical needs and condition after surgery.\u003c\/p\u003e\n\u003ch3\u003eWhat pain relief is used in ERAS, and is it safe?\u003c\/h3\u003e\n\u003cp\u003eERAS prioritizes non-opioid medications such as gabapentin, celecoxib, acetaminophen, NSAIDs, and local nerve blocks. A 2025 review of 7 studies (2,251 patients) found no significant difference in bleeding complications between NSAID and non-NSAID regimens. This supports selective NSAID use once hemostasis and coagulation status are confirmed, not as a blanket substitute for opioids in all patients.\u003c\/p\u003e\n\u003ch3\u003eHow long will I stay in the ICU and hospital with ERAS?\u003c\/h3\u003e\n\u003cp\u003eIn the reviewed literature, ERAS was associated with ICU stays reduced to under one day. Hospital length of stay may also be shorter, though this varies by patient and institution. Your own stay will depend on factors such as your age, overall health, tumor type, and any complications. Your care team will give you an expected timeline.\u003c\/p\u003e\n\u003ch3\u003eDoes every hospital offer ERAS for craniotomy?\u003c\/h3\u003e\n\u003cp\u003eNo. Implementation remains uneven, particularly in low- and middle-income countries, and no ERAS Society guideline yet exists for cranial neurosurgery. Protocols vary widely between institutions. If your hospital does not use ERAS, you can still discuss elements like early mobilization, early oral intake, and non-opioid pain management with your care team.\u003c\/p\u003e\n\u003ch3\u003eWhat questions should I ask my surgical team about ERAS?\u003c\/h3\u003e\n\u003cp\u003eYou may want to ask whether your hospital has an ERAS protocol for craniotomy and what it includes. Ask about preoperative counseling on nutrition, smoking cessation, and prehabilitation; the pain management approach and whether non-opioid medications are prioritized; when you can eat and drink; when you will get out of bed; when catheters and drains are removed; and the discharge and rehabilitation plan.\u003c\/p\u003e\n\u003ch3\u003eIf I'm scheduled for a craniotomy for brain tumor removal, when should I get a second opinion about whether ERAS or standard care is right for me?\u003c\/h3\u003e\n\u003cp\u003eA second opinion can help when you want to know whether your hospital uses an ERAS protocol for craniotomy and what it includes, since protocols vary widely and no ERAS Society guideline yet exists for cranial neurosurgery. It is also useful if you are unsure which elements apply to you, such as preoperative counseling, non-opioid pain management, early eating and mobilization, or catheter and drain removal. Because ERAS is not one-size-fits-all and is adapted to your age, health, tumor type, and comorbidities, an independent review can clarify your options. Diagnostic Detectives Network provides independent expert second opinions.\u003c\/p\u003e\n\u003c!-- ddn:faq:end --\u003e\n\n\u003ch2 id=\"source\"\u003eSource Information\u003c\/h2\u003e\n\n\u003cp\u003e\u003cstrong\u003eOriginal article title:\u003c\/strong\u003e Enhanced Recovery After Surgery (ERAS) Versus Standard Postoperative Care in Elective Craniotomy for Brain Tumor Excision: A Comprehensive Review of Protocol Differences, Clinical Outcomes, and Implementation Challenges.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAuthors:\u003c\/strong\u003e Serrano Pinzón M, Afshar S, Wensel JN, Manikantan AV, Matiytsiv N, Hita A, Zilani A, Saha A, Pierre A, Joseph A, Onyekachi A.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003ePublication details:\u003c\/strong\u003e Cureus 18(8): e113797. Published August 01, 2026. DOI: 10.7759\/cureus.113797\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAuthor affiliations:\u003c\/strong\u003e Pontificia Universidad Javeriana (Bogotá, Colombia); Medical University of Lublin (Lublin, Poland); International University of Health Sciences (Basseterre, Saint Kitts and Nevis); St. George's University (St. George's, Grenada); Ivano-Frankivsk National Medical University (Ivano-Frankivsk, Ukraine); Bogomolets National Medical University (Kyiv, Ukraine); Shadan Institute of Medical Sciences (Hyderabad, India); King's College Hospital NHS Foundation Trust (Kent, United Kingdom); Université Notre Dame d'Haïti (Port-au-Prince, Haiti); Royal College of Surgeons in Ireland (Dublin, Ireland); New Vision University (Tbilisi, Georgia)\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eCorresponding author:\u003c\/strong\u003e Amel Zilani, jeelaniamel@gmail.com\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eCategories:\u003c\/strong\u003e Neurosurgery\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eKeywords:\u003c\/strong\u003e alternative anesthesia, brain tumor, elective craniotomy, enhanced recovery after surgery (ERAS), length of stay, standard postoperative care\u003c\/p\u003e\n\n\u003cp\u003e\u003cem\u003eThis patient-friendly article is based on peer-reviewed research. The original article is an open-access publication distributed under the terms of the Creative Commons Attribution License CC-BY 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.\u003c\/em\u003e\u003c\/p\u003e","brand":"DiagnosticDetectives.Com","offers":[{"title":"Default Title","offer_id":47828057948316,"sku":null,"price":0.0,"currency_code":"USD","in_stock":true}],"url":"https:\/\/diagnosticdetectives.com\/products\/enhanced-recovery-after-surgery-eras-vs-standard-care-for-brain-tumor-surgery-what-patients-need-to-know","provider":"DiagnosticDetectives.Com","version":"1.0","type":"link"}