The global demand for hospital care, driven by population growth and medical advances, emphasizes the importance of optimized resource management. Enhanced Recovery After Surgery (ERAS) protocols aim to expedite patient recovery and reduce health care costs without compromising patient safety or satisfaction. Its principles have been adopted in various surgical specialties but have not fully encompassed all areas of neurosurgery, including craniotomy. ERAS for craniotomy has been shown to reduce the length of hospital stay and costs without increasing complications. ERAS protocols may also reduce postoperative nausea and vomiting and perioperative opioid requirements, highlighting their potential to enhance patient outcomes and health care efficiency. Despite these benefits, guidelines, and strategies for ERAS in craniotomy remain limited. This narrative review explores the current global landscape of ERAS for craniotomy, assessing existing literature and highlighting knowledge gaps. Experts from 26 countries with diverse cultural and socioeconomic backgrounds contributed to this review, offering insights about current ERAS protocol applications, implementation challenges, and future perspectives, and providing a comprehensive global overview of ERAS for craniotomy. Representatives from all 6 World Health Organization geographical world areas reported that barriers to the implementation of ERAS for craniotomy include the absence of standardized protocols, provider resistance to change, resource constraints, insufficient education, and research scarcity. This review emphasizes the necessity of tailored ERAS protocols for low and middle-income countries, addressing differences in available resources. Acknowledging limitations in subjectivity and article selection, this review provides a comprehensive overview of ERAS for craniotomy from a global perspective and underscores the need for adaptable ERAS protocols tailored to specific health care systems and countries.

Department of Anesthesia Aga Khan University Hospital Nairobi Kenya

Department of Anesthesia and Critical Care Anaesthesia Institute Cleveland Clinic Abu Dhabi UAE

Department of Anesthesia and Critical Care Hospital Kuala Lumpur Kuala Lumpur Malaysia

Department of Anesthesia and Intensive Care Medicine Charles University Prague 3rd Faculty of Medicine Prague Czech Republic

Department of Anesthesia and Intensive Care Medicine Jessa Hospital Hasselt Belgium

Department of Anesthesia and Intensive Care Medicine Perioperative Services Intensive Care Medicine and Pain Management Turku University Hospital University of Turku Turku Finland

Department of Anesthesia and Pain Medicine Toronto Western Hospital University of Toronto Toronto ON Canada

Department of Anesthesia and Surgery Aarhus University Hospital Aarhus Denmark

Department of Anesthesia Beaumont Hospital Dublin Ireland

Department of Anesthesia Beijing Tiantan Hospital Capital Medical University Beijing China

Department of Anesthesia Chris Hani Baragwanath Academic Hospital University of the Witwatersrand Johannesburg South Africa

Department of Anesthesia Cleveland Clinic Cleveland OH

Department of Anesthesia Hospital das Clínicas Faculty of Medicine University of São Paulo São Paulo Brazil

Department of Anesthesia Institute of Medicine Tribhuvan University Kathmandu Nepal

Department of Anesthesia Kilimanjaro Christian Medical Center Moshi Tanzania

Department of Anesthesia Philippine General Hospital University of the Philippines Manila Manila Philippines

Department of Anesthesia Prince Sultan Military Medical City Saudi Anaesthesia Scientific Council Riyadh Saudi Arabia

Department of Anesthesia Rambam Health Care Campus Haifa Israel

Department of Anesthesia The Aga Khan University Karachi Pakistan

Department of Anesthesia Universitas Gadjah Mada Yogyakarta Indonesia

Department of Anesthesia University Teaching Hospital Lusaka Zambia

Department of Neuro Anaesthesia The Walton Centre Liverpool UK

Department of Neuroanaesthesia and Critical Care All India Institute of Medical Sciences New Delhi India

Department of Neuroanesthesia at Hamad General Hospital Doha Qatar

Department of Neuroanesthesia Manuel Velasco Suárez National Institute of Neurology and Neurosurgery Mexico City Mexico

Department of Neurological Surgery Marqués de Valdecilla University Hospital Santander Spain

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