[Current State of ERAS Implementation in Thoracic Surgery in Germany]

Area of Science:

• Thoracic Surgery
• Surgical Outcomes
• Evidence-Based Medicine

Background:

• Enhanced Recovery After Surgery (ERAS) pathways are increasingly adopted across surgical disciplines to improve patient outcomes and recovery.
• The first ERAS guidelines for thoracic surgery were published in 2019 by the ERAS Society and the European Society of Thoracic Surgeons (ESTS).

Purpose of the Study:

• To evaluate the current implementation status of ERAS items in clinical practice within German thoracic surgery.
• To identify variations and challenges in the adoption of ERAS guidelines among thoracic surgeons.

Main Methods:

• An online survey was conducted between May 12 and June 1, 2021.
• The survey comprised 22 questions focusing on key ERAS program elements as defined by published guidelines.
• Results were descriptively analyzed and contextualized with existing literature.

Main Results:

• Only 28.1% of responding hospitals had established an ERAS core unit, and 15.6% maintained a database for ERAS items.
• Preoperative ERAS diaries were used by only 3.1% of surgeons; carboloading was performed by 15.6%.
• While standard postoperative nausea and vomiting (PONV) prophylaxis was common (59.4%), variations existed in pleural drainage (single drain in 84.4%) and suction levels, with most using -10 cmH2O.

Conclusions:

• Implementation of ERAS guidelines in German thoracic surgery centers shows considerable variability.
• Certain perioperative processes are adequately addressed, but the full integration of core ERAS features into daily practice remains incomplete.
• Initial steps towards standardization have been taken, providing a basis for future multi-center collaboration.