Five-Year Sustained Impact of a Thoracic Enhanced Recovery After Surgery Program.

Area of Science:

• Thoracic Surgery
• Enhanced Recovery Programs
• Surgical Outcomes

Background:

• Enhanced Recovery Programs (ERP) aim to optimize surgical patient care.
• Previous studies indicated ERPs can reduce postoperative morphine equivalents and hospital costs.
• The sustainability and long-term benefits of a thoracic surgery ERP needed further evaluation.

Purpose of the Study:

• To evaluate the sustainability and impact of a thoracic surgery enhanced recovery program (ERP).
• To assess the program's effect on postoperative opioid use, hospital costs, and patient outcomes.
• To determine if the thoracic ERP could become a standard of care.

Main Methods:

• Prospective analysis of 1079 patients undergoing elective thoracic surgery from 2015 to 2021.
• Comparison of outcomes before (pre-ERP) and after (ERP era) program implementation (May 1, 2016).
• Data collected included patient demographics, surgical approach (VATS vs. thoracotomy), opioid consumption, hospital costs, and complication rates.

Main Results:

• The ERP era included 79% of patients, showing significant reductions in hospital stay (1.5 days for thoracotomy, 1 day for VATS).
• Median postoperative morphine equivalents decreased substantially (e.g., 125mg to 45mg for thoracotomy; P < .001).
• Total admission costs were reduced, and postoperative atrial fibrillation and urinary retention rates decreased.

Conclusions:

• The thoracic surgery ERP is sustainable and effectively improves patient outcomes.
• The program significantly decreases opioid utilization and lowers hospital expenditures.
• The demonstrated benefits suggest the enhanced recovery program has the potential to be adopted as the standard of care in thoracic surgery.