Enhanced recovery in cranial surgery (ERACraS) - A single-centre quality improvement study.

BACKGROUND: Enhanced Recovery After Surgery (ERAS) is a well-established, protocol-driven, evidence-based approach to peri-operative care. ERAS protocols have been used to improve patient morbidity and mortality outcomes in various surgical specialties. More recently, it has been introduced to neurosurgery. Our aim was to establish an Enhanced Recovery After Cranial Surgery (ERACraS) protocol for patients as part of a quality improvement project (QIP) with the intention of reducing hospital length of stay (HLOS). METHODS: This QIP was carried out in the Department of Neurosciences (DCN), Edinburgh, over two four-month periods. A total of 40 patients over 18 years of age undergoing elective craniotomy surgery under a sole neurosurgeon were invited to take part in this QIP. Subsequently, data was retrospectively collected through our institution's online documentation system. RESULTS: 19 patients received conventional perioperative care (pre-ERACraS group) during December 2021-March 2022, and 21 received care according to the novel ERACraS (ERACraS group) during June-September 2022. Regarding supra-tentorial surgery, there was a reduction of 73% in HLOS in the ERACraS group. No change was observed in infra-tentorial surgery. Overall, the ERACraS protocol reduced HLOS by 50% in cranial surgery. CONCLUSION: The QIP data from ERACraS in our unit has shown that implementing ERAS protocols is feasible. A reduction in HLOS has implications for patient morbidity, mortality, and quality of care. We endeavour to collect long-term data by collaborating with neurosurgical units across the UK and Ireland to validate its feasibility and sustainability as part of a major QIP in neurosurgical practice. This can be potentially adopted by neurosurgical centres across the globe in a safe and sustained manner.

Do wild suids from Ndumo Game Reserve, South Africa, play a role in the maintenance and transmission of African swine fever to domestic pigs?

Warthogs (Phacochoerus africanus) and bushpigs (Potamochoerus larvatus) are considered as the wild reservoirs of ASF. They are both present in Ndumo Game Reserve (NGR), located in the Northern South African Province of KwaZulu on the border with Mozambique. In that area, the occurrence of tick-warthog sylvatic cycle of ASF has been suspected for years. To assess if wild suids represent a risk of ASF virus spillover to domestic pigs, wild suid abundance and incursions outside NGR boundaries were estimated using transect counts, fence patrols and camera traps. Also, the presence of Ornithodoros ticks was explored in 35 warthog burrows within NGR. In addition, blood samples were taken from 67 domestic pig farms located outside NGR to be tested for ASF antibodies. Information on interactions between domestic and wild suids and ASF occurrence was gathered using interviews with pig farmers (n = 254) in the study area. In conclusion, the bushpigs and warthog's population estimates in NGR are 5 and 3-5 individuals/km2 , respectively. Both species move out of the reserve regularly (15.4 warthogs/day and 6.35 bushpigs/day), with movements significantly increasing in the dry season. Some farmers observed warthogs and bushpigs as far as 8 and 19 km from NGR, respectively, but no reports of direct wild-domestic suids interactions or ASF outbreaks. Also, no soft ticks were detected in all warthog burrows and all the pig blood samples were negative for ASF antibodies. The absence of ticks in warthog burrows, the absence of antibodies in pigs sampled, the absence of reported outbreaks, and no familiarity with ASF in the study area, suggest that a sylvatic cycle of ASF is, at present, unlikely in NGR. This conclusion must be confirmed by a larger survey of warthog burrows and monitoring potential antibodies in warthogs from NGR.