Clinical Research Coordinator University of Miami Hospital Buenos Aires, Argentina
Introduction: The concept of enhanced recovery after surgery (ERAS) due to standardized interventions has been gaining relevance within neurosurgery. Advances have been made both in spine and cranial surgery. These experiences report many benefits such as a reduction in hospitalization days, without increasing the incidence of complications. However, no experience has described to date the applicability of an ERAS program for laser ablation thermal therapy (LITT). Here we describe the first multidisciplinary ERAS preliminary protocol for LITT.
Methods: We performed a retrospective analysis of all adult patients who underwent LITT for oncological lesions from 2013 to 2021. During this time, a series of pre-, intra-, and post-operative adjustments were made to the admission course and surgical/anesthesia workflow with the goal of improving recovery. A multidisciplinary program was created by protocolizing interventions carried out along the path of the patient's hospitalization. Each recommendation was individually assessed for its appropriateness for enhancing recovery and for its validity with a focused literature review process.
Results: A total of 184 patients were included, with a mean age of 60.7 ± 13.5 years, 35% males. 167 tumors were located in the supratentorial compartment, and 17 were infratentorial; the mean tumor diameter was 1.84 ± 1.04 cm. Among the pathologies treated 50.0% were metastasis, and 36.9% were glioblastomas. The mean postoperative day discharge was 1.2 ± 0.8 days. The readmission rate due to surgical complications within 30 days of surgery was 2.2%. These readmission rates fall into what is published in the literature without an ERAS program and longer hospital admissions. One death was recorded in the perioperative period.
Conclusion : This preliminary study shows the proposed LITT protocol to be a safe means of discharging patients on post-operative day 1 while preserving outcomes. This study could be useful as a preliminary framework for the development of future guidelines.
