Evidence map›Paper›PMID 41528532›Full record

SynthesisNeurosurgical review2026

Level of evidence of enhanced recovery after surgery (ERAS) strategies for elective craniotomy: An updated systematic review.

Jacopo Bellomo, Valérie Blom, Vittorio Stumpo, Menno R Germans, Philipp Bardelli, Luca Regli, Carlo Serra, Victor E Staartjes, Christian Möhrlen

Abstract readSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Neurosurgical review, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Jacopo BellomoMachine Intelligence in Clinical Neuroscience & Microsurgical Neuroanatomy (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Valérie BlomMachine Intelligence in Clinical Neuroscience & Microsurgical Neuroanatomy (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Vittorio StumpoMachine Intelligence in Clinical Neuroscience & Microsurgical Neuroanatomy (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Menno R GermansMachine Intelligence in Clinical Neuroscience & Microsurgical Neuroanatomy (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Philipp BardelliInstitute of Anesthesiology and Perioperative Care Medicine, University Hospital Zurich, Zurich, Switzerland.
Luca RegliMachine Intelligence in Clinical Neuroscience & Microsurgical Neuroanatomy (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Carlo SerraMachine Intelligence in Clinical Neuroscience & Microsurgical Neuroanatomy (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Victor E Staartjes *Machine Intelligence in Clinical Neuroscience & Microsurgical Neuroanatomy (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland. victoregon.staartjes@usz.ch.
Christian Möhrlen *Institute of Anesthesiology and Perioperative Care Medicine, University Hospital Zurich, Zurich, Switzerland.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Enhanced Recovery After Surgery (ERAS) protocols offer evidence-based, multimodal strategies to optimize perioperative care and improve outcomes. While extensively studied in other surgical specialties, ERAS implementation in cranial neurosurgery remains underexplored. This study systematically reviews the current evidence on ERAS elements and protocols for elective craniotomy, evaluating their impact on clinical and economic outcomes. An updated systematic review of the literature was conducted using PubMed, Embase, Scopus, and the Cochrane Library. Interventional and observational studies examining pre-, intra-, or postoperative interventions to improve outcomes such as length of stay, complications, or patient satisfaction were included. Two independent reviewers conducted screening, data extraction, and risk-of-bias assessments, with quality grading based on the GRADE framework. Sixty-six studies were included, comprising 39 newly identified and 27 from the prior review. The evidence demonstrated significant heterogeneity in ERAS interventions and study methodologies. Frequently studied elements included preoperative carbohydrate loading and education, intraoperative scalp nerve blocks as well as short-acting and opioid-sparing anesthetic regimens, avoidance of routine wound drains, postoperative early mobilization, clear criteria for same-day or early discharge protocols, avoidance of routine ICU admission, and comprehensive ERAS protocols. Only 33 studies quantitatively reported protocol adherence. According to GRADE assessment, most elements were supported by "low" level of evidence mainly due to heterogeneous methodology, small sample sizes, non-randomized study designs, and limited prospective validation. There has been a significant influx of evidence concerning the application of ERAS in cranial surgery. Our systematic review provides a comprehensive summary of the body of evidence on pre-, intra-, and postoperative interventions as well as established ERAS institutional protocols. While overall evidence quality remains limited by heterogeneity and incomplete adherence reporting, these components may be safe and effective and serve as priority targets for ERAS implementation in elective craniotomy pathways. Future research should focus on multicenter prospective validation, adherence monitoring, and inclusion of underrepresented patient populations to optimize ERAS integration in neurosurgical practice.

Indexed as

CraniotomyElective Surgical ProceduresEnhanced Recovery After SurgeryPerioperative CareHumansCraniotomyEnhanced recoveryEnhanced recovery after surgeryERASLevel of evidenceNeurosurgery

Identifiers

PMID41528532

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.