Perioperative anesthesia management for video-assisted thoracoscopic surgery procedures in Austria : A national...

Video-assisted thoracoscopic surgery (VATS) is widely used for anatomical lung resections. Despite available enhanced recovery after surgery (ERAS) recommendations, perioperative management may vary between institutions. This survey assessed current perioperative practice for VATS procedures in Austria.

A structured questionnaire comprising 19 items was distributed to all anesthesia departments performing thoracic surgery in Austria (n = 13) in February 2024. The survey addressed institutional characteristics, airway management, intraoperative anesthesia strategies, monitoring practices and perioperative analgesia. Data were analyzed descriptively.

A total of 10 centers responded (response rate 76.7%) but 1 center did not perform VATS procedures and was excluded from the practice-based analysis; therefore, 9 centers performing VATS were analyzed. Annual VATS case volume ranged from 48-800 procedures. An established ERAS program was reported by three centers (33.3%), while implementation was planned in two centers (22.2%). Airway management varied, with direct laryngoscopy, video laryngoscopy and user-dependent intubation strategies reported. Conventional double-lumen tubes were used as the primary device in six centers (66.7%), whereas camera-assisted double-lumen tubes were used in three centers (33.3%). Routine invasive arterial monitoring was reported by six centers (66.7%) and immediate extubation in the operating room was routine in eight centers (88.9%). Regional anesthesia techniques varied considerably, whereas systemic analgesia was applied more consistently.

This national survey demonstrates substantial intercenter variability in perioperative management of VATS procedures in Austria, particularly regarding ERAS implementation, airway management and regional analgesia strategies. The clinical impact of this variability remains unknown because patient outcomes were not assessed.