Effects of enhanced recovery after surgery-based nursing on clinical outcomes, psychological well-being, and quality of life in patients undergoing craniotomy for intracranial tumors

Background Intracranial tumor resection carries considerable risk and technical complexity. This study evaluates an Enhanced Recovery After Surgery (ERAS) nursing protocol on clinical recovery, psychological well-being, and quality of life. Methods This prospective non-randomized comparative (quasi-experimental) study enrolled 162 patients undergoing elective craniotomy for intracranial tumors, allocated to an ERAS nursing group (EG; n = 81) or conventional care group (CG; n = 81) by admission ward. The primary outcome was length of hospital stay. Secondary outcomes included postoperative complications, recovery milestones, pain, in-hospital mortality, psychological well-being (Hamilton Anxiety [HAMA] and Depression [HAMD] Rating Scales), and health-related quality of life (SF-36), assessed preoperatively and on postoperative day 7. Between-group comparisons used unadjusted tests and multivariable models with prespecified covariates; the Benjamini–Hochberg procedure was applied to SF-36 domains. Results Length of stay was shorter in the EG (9.2 ± 3.2 vs. 10.4 ± 3.8 days; mean difference −1.2 days, 95% CI −2.3 to −0.1; p = 0.031), and remained shorter after adjustment (−1.1 days, 95% CI −2.2 to −0.1; p = 0.038). Complications were less frequent in the EG (11.1% vs. 28.4%; unadjusted OR 0.31, 95% CI 0.13–0.72; p = 0.006; adjusted OR 0.34, 95% CI 0.14–0.81; p = 0.015). Times to first bowel movement, first defecation, and first solid food intake were all reduced (all p < 0.001), as was VAS pain at rest at 72 h (2.8 ± 1.2 vs. 4.6 ± 1.6; p < 0.001). On postoperative day 7, baseline-adjusted HAMA and HAMD scores were lower in the EG ( p = 0.005 and p = 0.018), and SF-36 scores were higher across all eight domains and both component summaries (all Benjamini–Hochberg-adjusted p < 0.001). Conclusion ERAS-based nursing was associated with shorter hospital stay, fewer complications, lower anxiety and depression, and higher quality of life after craniotomy for intracranial tumors. Given the non-randomized design, findings represent associations rather than causal effects; multicenter randomized validation with long-term follow-up is warranted.