Institutional Development of an Enhanced Recovery after Surgery (ERAS) Protocol for Endoscopic Endonasal Skull Base Surgery

Introduction: Enhanced recovery after surgery (ERAS) or simply enhanced surgical recovery (ESR) is a comprehensive paradigm spanning preoperative, intraoperative, and postoperative care to minimize the perioperative morbidity from surgery. ERAS initiatives have been previously published in spinal neurosurgery but little attention has been given to the use of ERAS after endoscopic endonasal skull base surgery.

Methods: Combination of multidisciplinary expert opinion and published literature review to create an endoscopic endonasal skull base surgery ERAS protocol at a high-volume tertiary medical center.

Results: Our group focused on the following perioperative parameters to optimize: prehabilitation of nutrition and glycemic control, reduced NPO time the day of surgery, multimodality pain management begun preoperatively, intraoperative medication use, rapid discontinuation of invasive monitoring and catheters, and rapid mobilization after surgery. Best practices were implemented based on identification and review of non-EEA peer-reviewed literature and expert opinion in all of these areas. A patient handout was also developed, to improve preoperative education. A multidisciplinary team of neurosurgeons, anesthesiologists, pharmacists, nursing, and others came to consensus for the development of the guidelines.

Discussion: We have developed an ERAS endoscopic endonasal surgery protocol for our institution and are sharing it to advance perioperative care of these complex and unique patients. Future validation of improved outcomes using an ERAS protocol will be forthcoming, although multisite adoption may be necessary to show improved outcomes given the overall favorable morbidity profile of EEA surgery.

Publication History

Article published online:
01 February 2023