[Enhanced recovery after lung resection in high-risk patients]

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Critical Care Medicine

Context:

• High-risk patients undergoing lung resection present unique challenges due to comorbidities and complex surgical conditions.
• Preoperative risk stratification using Thoracoscore, Thoracic Revised Cardiac Risk Index, and ASA scores is crucial for patient management.
• Intraoperative findings such as severe adhesions and emphysematous lung tissue can complicate surgical procedures and recovery.

Purpose:

• To evaluate the feasibility and immediate outcomes of the Enhanced Recovery After Surgery (ERAS) program in high-risk patients undergoing lung resection.
• To assess the impact of ERAS elements on postoperative complications and mortality in this patient cohort.
• To identify optimal components of perioperative support within the ERAS framework for thoracic surgery.

Summary:

• A prospective study of 76 high-risk patients undergoing lobar resection demonstrated that while a full ERAS protocol adherence was challenging, incorporating specific elements like multimodal analgesia and early rehabilitation was beneficial.
• Postoperative abnormalities occurred in 40.8% of patients, with a 7.9% mortality rate. Critical complications impacted 13.1% of patients, leading to fatal outcomes in 7.9%.
• Minor and serious complications were more prevalent and effectively managed without fatal consequences, highlighting the potential for targeted interventions.

Impact:

• The study suggests that adapting and integrating individual ERAS components into perioperative care is a viable strategy for managing high-risk thoracic surgery patients.
• This approach can potentially mitigate complications and improve outcomes, even when a standardized protocol is not fully achievable.
• Findings support the tailored application of ERAS principles to optimize recovery in complex surgical populations.