Early enhanced recovery after lung surgery: early ambulation 1 hour after extubation

In this study, we describe our experience regarding the implementation of early enhanced recovery after lung surgery. We achieved early ambulation within 1 hour after extubation mainly by minimally invasive surgery combined with fast-track thoracic anesthesia.

We retrospectively analyzed the clinical outcomes of early enhanced recovery in 211 patients who underwent lung resection using miniport video-assisted thoracic surgery (VATS) by a multidisciplinary team in a single institution in the period from August 2018 to August 2019.

Out of the 211 patients, 178 achieved early ambulation 1 hour after extubation. The mean age of patients in the early ambulation group was 58.6±10.8 years, and 69 men and 109 women were included. The anesthesia time (100.8±26.6 minutes), extubation time (10±2.1 minutes), and operating time (71.1±25.3 minutes) were lower in the early ambulation group (P=0.001, P<0.001, and P=0.002, respectively). Segmentectomy was performed in 48.9% of patients in the early ambulation group. The mean length of postoperative hospital stay was 4.1±3.1 days, and the 30-day morbidity was 13.7% (29/211). Prolonged air leak was the main complication, which accounted for 75.9% (22/29). No reinsertion of chest tubes, no 30-day readmissions, and no reoperations in the postoperative 30-day period occurred in any of the patients.

Early enhanced recovery after lung surgery is feasible and safe, and may facilitate early ambulation and lay the foundation for the implementation of day surgery.