Development of a Neurosurgical Enhanced Recovery After Surgery (ERAS) Pathway




Assistant Professor of Neurosurgery

Project Summary

This summer, the Penn Undergraduate Research Mentoring Program introduced me to clinical research under the mentorship of Dr. Zarina Ali, working as a research assistant in the Neurosurgery department at Pennsylvania Hospital. In the last two decades, hospitals, mostly in the Western world, have been implementing a new protocol of care after surgery to improve patient outcomes, especially in colorectal and urological surgery. Differences between this protocol of Enhanced Recovery After Surgery, or ERAS, and traditional care include decreasing postoperative Foley catheter use, increasing in-house mobility, and increasing the use of multimodal analgesia to manage pain in the hospital.

 In April 2017, Pennsylvania Hospital (PAH) started implementing an ERAS protocol. The goal of my project was to find out the best methods to record and report on these new methods of care, track patients’ data throughout their surgical pathways, and determine whether ERAS protocols are as effective for neurosurgery as for other surgical disciplines.

I started by learning the chart system the hospital employed, which was crucial to extracting data. This data was then organized and analyzed with statistical tests such as the pooled method, the student t test, and the Fisher exact test. Since the ERAS implementation is still in its early days, the pilot statistical results we have are not conclusive of any larger patterns in the outcomes of care. However, the preliminary results show positive results and trends, such as decreased long-term opioid use, decreased length of stay, and a lower rate of admission to the ICU.

 While I worked on the main project, I read papers on ERAS protocols that mostly stemmed from the colorectal field. I learned how to show results in a way that match up to other papers in the field, as well as how our methods compared to other researchers’. Also, while building a central database, I have learned how to run statistical analyses on complex and imperfect data sets with RStudio. Additionally, I have learned a great deal about different aspects of neurosurgery and anesthesia.

This project gave me the chance to practice statistical analysis skills I learned in class and apply them to real-life data sets. Furthermore, it made me familiar with basic clinical research guidelines as well as how to carry out that research. As a mentor, Dr. Ali taught me about identifying confounding factors in data sets, presenting conclusions to colleagues, and writing manuscripts for publishing. This project showed me the many challenges inherent in implementing new clinical protocols. I would like to thank the PAH Neurosurgery Clinical Research Division, Dr. Ali, and PURM for giving me this opportunity to start research in the medical field, and for giving me exposure to what I hope to do with my career later on. I look forward to continuing this project in the fall.