Enhanced Recovery After Surgery (ERAS) Versus Standard Postoperative Care in Elective Craniotomy for Brain Tumor Excision: A Comprehensive Review of Protocol Differences, Clinical Outcomes, and Implementation Challenges.

Standard postoperative care following elective craniotomy traditionally includes close monitoring in an ICU setting, use of opioid-based analgesia, delayed initiation of oral intake, and prolonged bed rest. These practices may contribute to a longer recovery period, a higher risk of complications such as infections or deep vein thrombosis (DVT), and lower patient satisfaction. On the other hand, Enhanced Recovery After Surgery (ERAS) protocols offer a more structured and proactive approach. It incorporates preoperative counseling, carbohydrate loading (if appropriate), avoidance of prolonged fasting, and standardized anesthetic techniques that prefer shorter-acting agents. Postoperatively, ERAS prioritizes early removal of catheters and drains, early enteral diet, and rapid mobilization - all designed to help patients recover more efficiently. Across the literature reviewed here, ERAS is associated with concrete gains over standard care: postoperative nausea and vomiting falling from roughly 28.0% to 9.2% in one cohort, a Karnofsky Performance Status improvement of approximately 10 points sustained at 30 days (pooled mean difference 6.68 points), patient satisfaction of 92.2% versus 86.8%, ICU length of stay reduced to under one day, and per-patient cost reductions of $1,044-$4,026. Hospitals must undertake protocol development, arrange training, and ensure flexibility to adapt ERAS elements to each patient's clinical needs; implementation remains uneven across economic and resource settings, particularly in low- and middle-income countries. As interest in ERAS grows, further research and education will be essential to support wider and more effective practice across neurosurgical practices.