Standardized Recommendations for the Implementation of Enhanced Recovery Protocols in Thoracic Surgery in Spain: A...

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Anesthesiology
• Critical Care Medicine

Background:

• Lung resection surgery for lung cancer has significant complication risks despite minimally invasive advancements.
• Enhanced Recovery After Surgery (ERAS) protocols can improve outcomes but have inconsistent adoption.
• A need exists for standardized, evidence-based ERAS recommendations in thoracic surgery.

Purpose of the Study:

• To develop evidence-based recommendations for ERAS strategies in thoracic surgery.
• To incorporate multidisciplinary expert and patient insights into ERAS protocol development.
• To address the inconsistent adoption of ERAS protocols in lung cancer surgery.

Main Methods:

• A two-round Delphi consensus process involving thoracic surgery experts.
• Development of 62 recommendations across preoperative, intraoperative, and postoperative phases.
• Consensus defined as ≥66% agreement or disagreement on a Likert scale.

Main Results:

• High consensus achieved for preoperative (91.7%), intraoperative (86.7%), and postoperative (85%) recommendations.
• Key recommendations include prehabilitation, multimodal opioid-sparing analgesia, minimally invasive surgery, early drain removal, and early mobilization.
• Established a comprehensive set of 62 consensus-based recommendations for perioperative care.

Conclusions:

• A structured, consensus-based perioperative management protocol for thoracic surgery patients was established.
• Optimized perioperative care and standardized interventions aim to improve clinical outcomes and enhance recovery.
• Recommendations may facilitate broader ERAS adoption, improving patient recovery and resource utilization.