Implementation of an Enhanced Recovery After Surgery Protocol for Cranial Vault Remodeling Procedures

Purpose: As trends in healthcare focus on decreased hospital stays and improved patient outcomes it is important to provide protocols that address both. The authors aim to describe an enhanced recovery after surgery (ERAS) protocol for cranial vault remodeling procedures performed for patients with craniosynostosis at a tertiary care hospital. Methods: After IRB approval, all patients undergoing a cranial remodeling procedure for craniosynostosis at the authors' institution over a 10-year period were included. Patient and craniosynostosis demographics were collected as well as operative details. Primary outcome measures were intensive care unit length of stay (ICU LOS) and narcotic usage. Chi squared and Independent t-tests were utilized to determine significance (p < 0.05). Results: During the time period examined, there were 168 primary cranial vault remodeling procedures performed at the authors' institution. Use of the ERAS protocol was associated with decreased initial 24-hour morphine equivalent usage (p < 0.01) and decreased total morphine equivalent usage (p < 0.01). Patients using the ERAS protocol experienced a shorter ICU LOS (p < 0.01), but the total hospital length of stay was unchanged. These results remained true when strip craniectomy procedures were excluded. Conclusion: This study reiterates the benefit of developing and implementing an ERAS protocol for patients undergoing cranial vault remodeling procedures. The protocol resulted in an overall decreased ICU LOS and a decrease in narcotic use. This has implications for methods to maximize hospital reimbursement for these procedures, as well as potentially improve outcomes.