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Implementing a Thoracic Enhanced Recovery Program: Lessons Learned in the First Year.

Linda W Martin1, Bethany M Sarosiek2, Meredith A Harrison1

  • 1Thoracic and Cardiovascular Surgery, University of Virginia Health System, Charlottesville, Virginia.

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|March 7, 2018
PubMed
Summary
This summary is machine-generated.

Implementing enhanced recovery after surgery (ERAS) protocols for thoracic procedures significantly reduced patient recovery time, opioid use, and hospital costs within the first year. This approach optimizes patient care and resource utilization in thoracic surgery.

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Area of Science:

  • Thoracic surgery
  • Surgical protocols
  • Patient outcomes

Background:

  • Enhanced recovery after surgery (ERAS) protocols aim to minimize operational stress, improve patient experience, reduce variability, and optimize resource utilization.
  • A thoracic ERAS protocol was implemented to evaluate its impact on patient care and operational efficiency.

Purpose of the Study:

  • To assess the effectiveness of a thoracic ERAS protocol in improving patient outcomes and resource utilization.
  • To compare outcomes of ERAS protocols for video-assisted thoracic surgery (VATS) and thoracotomy against historic controls.

Main Methods:

  • Developed two ERAS protocols: one for VATS (ERAS-VATS) and one for thoracotomy (ERAS-T).
  • Protocols included preoperative education, carbohydrate loading, opioid-sparing analgesia, conservative fluid management, and early ambulation.
  • Compared ERAS patients with historic controls from the year prior to implementation, analyzing outcomes, length of stay, pain scores, opioid use, fluid administration, and costs.

Main Results:

  • ERAS-VATS patients showed significantly lower postoperative morphine equivalents (22 vs. 86 mg), reduced fluid balance (227 vs. 1279 mL), and lower adjusted hospital costs ($14,870 vs. $20,169) compared to historic VATS controls.
  • ERAS-T patients demonstrated significantly decreased median postoperative morphine equivalents (54 vs. 130 mg), improved fluid balance (-489 vs. 788 mL), shorter length of stay (4.0 vs. 6.0 days), and lower adjusted hospital costs ($26,089 vs. $41,950) compared to historic thoracotomy controls.

Conclusions:

  • Thoracic ERAS implementation is a dynamic process that can enhance outcomes in thoracic surgical procedures.
  • The first year of implementation resulted in a shorter length of stay, reduced opioid usage, minimized fluid overload, and decreased hospital costs.