Enhanced Recovery With Aggressive Ambulation Decreases Length of Stay in Lung Cancer Surgery

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Enhanced Recovery Protocols

Background:

• Minimally invasive lung cancer resection is standard care.
• Enhanced Recovery with Ambulation after Surgery (T-ERAS) protocols aim to optimize patient recovery.
• Early ambulation is a key component of T-ERAS.

Purpose of the Study:

• To compare the actual length of stay (LOS) of patients managed under the T-ERAS protocol against predicted LOS from a validated surgical risk calculator.
• To evaluate the effectiveness of the T-ERAS protocol in reducing hospital LOS for minimally invasive lung cancer resections.

Main Methods:

• Retrospective review of 886 patients undergoing minimally invasive lung cancer resection (2012-2022).
• Inclusion criteria: age ≥ 18 and documented early ambulation.
• Comparison of observed LOS with predicted LOS using the American College of Surgeon's National Surgical Quality Improvement Program (NSQIP) Risk Calculator.

Main Results:

• The T-ERAS cohort (n=886) had an average observed LOS of 1.2 days, compared to a predicted LOS of 3.4 days by NSQIP.
• 95% of T-ERAS patients experienced a LOS shorter than predicted (O/P ratio < 1).
• The mean observed/predicted LOS ratio was 0.34.

Conclusions:

• The T-ERAS protocol significantly shortens the average length of stay for patients undergoing minimally invasive lung cancer resection.
• This protocol demonstrates potential to reduce hospital LOS beyond predictions from established risk calculators like NSQIP.
• T-ERAS offers a viable strategy for optimizing patient recovery and resource utilization in thoracic surgery.