Enhanced Recovery After Surgery Protocol for Microvascular Decompression in Trigeminal Neuralgia: A Retrospective Matched Cohort Study.

Abstract

Background and objectives: Microvascular decompression (MVD) is an effective surgical treatment of trigeminal neuralgia, especially when medical therapy does not result in adequate pain control. Despite its efficacy, improvements can be made in the perioperative period to reduce hospital length of stay, enhance patient experience, improve outcomes, and reduce costs. An enhanced recovery after surgery (ERAS) protocol was implemented for patients, and a retrospective cohort study was used to compare outcomes with non-ERAS MVD patients.

Methods: In this matched cohort analysis, a total of 240 patients were initially included. After 1:1 propensity score matching, 130 patients were selected for the main analysis, with comorbidities and demographic factors controlled for in the comparison.

Results: ERAS-treated patients had significantly reduced hospital length of stay (P < .001) compared with the control group with a mean of 1.46 and 2.95 days, respectively. In addition, ERAS patients had similar postoperative Barrow Neurological Institute pain scores to non-ERAS patients, with significantly lower verbal pain scores (P = .03). Patients in the ERAS group experienced significantly lower rates of transient postoperative subjective hearing alteration (P = .03) compared with controls. In a subanalysis of patients in the ERAS group who were discharged at 24 hours, these patients reported lower postoperative verbal pain levels (P = .003) compared with non-ERAS patients. An analysis of covariance comparing postoperative pain scores (Barrow Neurological Institute and verbal pain) between the ERAS and non-ERAS groups controlled for length of stay, age, duration of symptoms, and preoperative pain scores and found no significant difference between the ERAS and non-ERAS groups.

Conclusion: Implementation of this ERAS protocol for MVD has significantly reduced the length of stay with similar, if not improved, pain levels and rates of transient postoperative subjective hearing alteration compared with non-ERAS patients.