Feasibility and efficacy of enhanced recovery after surgery protocol in Chinese elderly patients with intracranial aneurysm

Figures & data

Table 1 ERAS strategy performed in this study

Strategy	Control group	ERAS group
Preoperative
Preoperative education	Conventional	Detailed (ERAS strategy)
Oral diet	Nothing for 8 hours before operation	Fluids until 2 hours and solids until 6 hours before operation
Short-acting anxiolytics	Occasionally	Conventional
Corticosteroid and antiemetic	Occasionally	Conventional
Operative
Patient-controlled analgesia pump	No	Yes
Nasogastric tube	Conventional	Minimized
Room temperature	Conventional	>25°C
Heated liquid	No	Yes
Warm air	No	Yes
Fluid administration	Conventional	Goal-directed manner
Postoperative
Urinary catheter removal	Three days after operation	One day after operation
Water	Twelve hours after operation	Six hours after operation
Liquid food	Two days after operation	One day after operation
Semiliquid diet	Three or four days after operation	Two days after operation
Normal diet	Five or six days after operation	Three days after operation
Fluid administration	Conventional	Restricted (<2,500 mL)
Patient-controlled analgesia pump	No	Yes
Pulmonary physical therapy	No	Conventional
Instrument after discharge	Self-determination of patients	Phone reminder, detailed and frequent

Abbreviation: ERAS, enhanced recovery after surgery.

Table 2 Baseline features of all patients divided into ERAS and control groups

Features	All patients (n=300)	Control group (n=150)	ERAS group (n=150)	P-value
Age, years	65 (64–67)	65 (64–67)	65 (64–68)	0.451
Males, n (%)	140 (46.7)	69 (46.0)	71 (47.3)	0.817
Hypertension, n (%)	158 (52.7)	77 (51.3)	81 (54.0)	0.644
Diabetes mellitus, n (%)	85 (28.3)	39 (26.0)	46 (30.7)	0.370
Aneurysmal location, n (%)				0.705
Posterior communicating and anterior choroidal aneurysm	151 (50.3)	79 (52.7)	72 (48.0)
Middle cerebral aneurysm	70 (23.3)	34 (22.7)	36 (24.0)
Anterior communicating aneurysm	79 (26.3)	37 (24.7)	42 (28.0)
Aneurysmal number >1 per patient, n (%)	21 (7.0)	10 (6.7)	11 (7.3)	0.821
Aneurysmal diameter >5 mm, n (%)	63 (21.0)	29 (19.3)	34 (22.7)	0.478
Lobular aneurysm, n (%)	84 (28.0)	38 (25.3)	46 (30.7)	0.304

Abbreviation: ERAS, enhanced recovery after surgery.

Table 3 Clinical outcomes of all patients divided into ERAS and control groups

Outcomes	Control group (n=150)	ERAS group (n=150)	P-value
Length of hospital stay, days	10 (8–12)	9 (7–11)	0.019
Readmission, n (%)	4 (2.7)	2 (1.3)	0.680
GOS at discharge, n (%)
5	143 (95.3)	147 (98.0)	0.198
4	7 (4.7)	3 (2.0)
MRS at discharge, n (%)
0–1	134 (89.3)	143 (95.3)	0.148
2	9 (6.0)	4 (2.7)
3	7 (4.7)	3 (2.0)
GOS at follow-up, n (%)
5	138 (92.0)	146 (97.3)	0.040
4	12 (8.0)	4 (2.7)
MRS at follow-up, n (%)
0–1	126 (84.0)	140 (93.3)	0.034
2	12 (8.0)	6 (4.0)
3	12 (8.0)	4 (2.7)

Abbreviations: ERAS, enhanced recovery after surgery; GOS, Glasgow Outcome Scale; MRS, Modified Rankin Scale.