Enhanced recovery after surgery (ERAS) for elective glioma craniotomy: a propensity score-matched retrospective cohort study
In brief
ERAS pathway cuts total hospital stay by three days for glioma craniotomy
In a propensity-matched analysis of 53 glioma patients, the enhanced recovery protocol reduced median total hospitalization from 12 to 9 days and postoperative stay from 9 to 7 days, without raising ICU time, costs, or complications. Early pre-op carbohydrate loading and oral fluids within eight hours after surgery drove the shorter stays, but larger multicenter trials are needed to confirm these findings.
- Journal
- Neurosurgical review (Q1)
- Published
- 6 August 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Rachakorn Punyasiri, Anukoon Kaewborisutsakul, Thakul Oearsakul, Thara Tunthanathip, Chin Taweesomboonyat, Chanatthee Kitsiripant, et al.
- PMID
- 42560602
- DOI
- 10.1007/s10143-026-04439-y
Why clinicians should know about it
- Picked for Histology (top studies of the week, 9 August 2026).
- Picked for Neurosurgery (top studies of the week, 9 August 2026).
Abstract
Although enhanced recovery after surgery (ERAS) has demonstrated benefits in various surgical specialties, evidence supporting its application in elective glioma craniotomies remains limited. This study compared the institutional ERAS pathway with conventional perioperative care in adults undergoing elective craniotomy for a single cerebral glioma. This retrospective cohort study (2019-2024) at a Thai university hospital enrolled patients aged ≥ 15 years with histologically confirmed gliomas. Propensity score matching (PSM; 1:1) addressed measured baseline confounding, and inverse probability of treatment weighting (IPTW) served as a sensitivity analysis. The primary outcomes were total hospital length of stay (LOS), intensive care unit (ICU) LOS, and postoperative LOS. Of 153 eligible patients (ERAS, n = 58; conventional, n = 95), PSM yielded 53 matched pairs. The ERAS group had shorter median total (9 vs. 12 days; p = 0.004) and postoperative (7 vs. 9 days; p = 0.037) LOS, with equivalent ICU LOS, hospitalization costs, and complication rates. The results of the IPTW analysis were directionally consistent. In multivariable logistic regression analyses, 2-hour preoperative carbohydrate loading (adjusted odds ratio [95% confidence interval] 5.98 [1.08-33.02], p = 0.040) and early oral fluid intake within postoperative 8 h (5.74 [1.22-26.96], p = 0.027) independently predicted a short postoperative LOS (< 7 days). Thus, ERAS was associated with shorter hospital stay without increased complications. Preoperative carbohydrate loading and early oral fluid intake were independently associated with a short postoperative LOS, identifying them as high-priority targets for a pragmatic, stepwise implementation strategy for ERAS in elective glioma craniotomies. Prospective multicenter studies are required to further optimize this pathway.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.