TY - JOUR
T1 - Enhanced recovery after brain tumor surgery
T2 - pilot protocol implementation in a large healthcare system
AU - Sivakumar, Walavan
AU - Guan, Jian
AU - Langevin, Jean Philippe
AU - Barkhoudarian, Garni
AU - Kelly, Daniel F.
AU - Martin, Neil
N1 - Publisher Copyright:
© AANS 2023, except where prohibited by US copyright law
PY - 2023
Y1 - 2023
N2 - 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.
AB - 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.
KW - ERAS
KW - Value Oriented Architecture
KW - brain surgery
KW - cost per case
KW - craniotomy
KW - enhanced recovery after surgery
KW - neurosurgery
UR - http://www.scopus.com/inward/record.url?scp=85178330160&partnerID=8YFLogxK
U2 - 10.3171/2023.9.FOCUS23563
DO - 10.3171/2023.9.FOCUS23563
M3 - Article
C2 - 38039543
AN - SCOPUS:85178330160
SN - 1092-0684
VL - 55
JO - Neurosurgical Focus
JF - Neurosurgical Focus
IS - 6
M1 - E5
ER -