Thoracic Enhanced Recovery After Surgery: Single Academic Center Observations After Implementation

Area of Science:

• Thoracic Surgery
• Perioperative Care
• Evidence-Based Medicine

Background:

• Enhanced Recovery After Surgery (ERAS) is a multidisciplinary perioperative care model.
• ERAS aims to reduce complications and hospital length of stay (LOS).
• Previous studies on ERAS for thoracic surgery yielded mixed results.

Purpose of the Study:

• To evaluate the impact of preliminary ERAS protocol implementation on lung resection outcomes.
• To compare ERAS protocol with conventional care at a single academic institution.

Main Methods:

• Observational study comparing pre-ERAS and post-ERAS cohorts.
• Adult patients undergoing lung resections were analyzed.
• Data collected included demographics, preoperative, anesthesia, and surgical variables; LOS; complications; and 30-day outcomes.

Main Results:

• 264 patients were included, evenly split between pre-ERAS and post-ERAS groups.
• No significant differences were observed in LOS, complications, or 30-day outcomes.
• Pulmonary complications, particularly prolonged air leaks, were a common cause of prolonged LOS.

Conclusions:

• The initial year of ERAS implementation did not significantly alter median LOS, complications, or 30-day outcomes.
• Prolonged air leaks were identified as a key factor contributing to extended LOS.
• Future thoracic ERAS protocols should focus on reducing air leaks and may consider early discharge with chest tubes.