Optimization of the Treatment Flow of Neurosurgical Patients with a Glioblastoma using the Enhanced Recovery After Surgery Methodology: A Literature Review

Abstract

Purpose: This study aims to create an elaborated version of the Enhanced Recovery After Surgery methodology, specifically applied to neurosurgical patients with a glioblastoma. Introduction: Being diagnosed with a glioblastoma is a terminal diagnosis with a median survival rate of 14,6 months. The introduction of an Enhanced Recovery After Surgery can provide a solution for current challenges such as the under-pressure health care system because of a lack of nurses and welltrained nurses in neurosurgical problems. Enhanced Recovery After Surgery benefits the patient, healthcare teams and society. Methods: A literature review with two different search strategies was conducted. First, the needs and expectations of patients with a glioblastoma were identified. Seventy-five papers from four databases, PubMed, Embase, CINAHL and Cochrane Library, were eligible. Fourteen papers were included in this study. Second, the existing Enhanced Recovery After Surgery protocols were examined. A total of 3,521 papers were screened by two independent researchers, of which 82 met the inclusion criteria and 50 were determined relevant for this study. In this way, an elaborated version of the Enhanced Recovery After Surgery methodology based on the needs of patients with a glioblastoma is created. Results: Patients with a glioblastoma may face numerous needs. Due to a poor diagnosis and uncertain future, they could feel distressed and anxious. Patients expect more information, support and availability from health professionals. Therefore, it is important for healthcare professionals to make sure that patients do not lose all hope after the diagnosis because losing hope is associated with depression and a poorer quality of life. All these needs were integrated in the Enhanced Recovery After Surgery protocol and combined with new insights from the literature. The first bundle of recommendations in the Enhanced Recovery After Surgery for patients with a glioblastoma belongs to the preoperative phase and includes: information and education, prehabilitation, nutrition support and fasting time, alcohol and smoking, comorbidities and medication. The intraoperative phase includes advice about antibiotics, body temperature, craniotomy, stitches and extubating. Finally, the postoperative phase includes recommendations regarding thromboembolism, nausea and vomiting, analgesics, oral nutrition, fluids, invasive lines, mobilization, urinary catheter, drains, discharge, telephone follow-up and social and emotional support. Conclusion: The established protocol needs to be constantly adapted to new evidence. Only with an appropriate multidisciplinary collaboration and thoughtful introduction of the Enhanced Recovery After Surgery, the implementation and sustainability of the new Enhanced Recovery After Surgery protocol will succeed in daily practice.