The main goal of enhanced recovery program after thoracic surgery is to minimize stress response, reduce postoperative pulmonary complications, and improve patient outcome, which will in addition decrease hospital stay and reduce hospital costs. As minimally invasive technique, video-assisted thoracoscopic surgery represents an important element of enhanced recovery program in thoracic surgery. Anesthetic management during preoperative, intraoperative and postoperative period is essential for the enhanced recovery. In the era of enhanced recovery protocols, non-intubated thoracoscopic procedures present a step forward. This article focuses on the key elements of the enhanced recovery program in thoracic surgery. Having reviewed recent literature, the authors highlight potential procedures and techniques that might be incorporated into the program.
The beginnings of the enhanced recovery after surgery (ERAS) program were first developed for patients in colorectal surgery, and after it was established as the standard of care in this surgical field, it began to be applied in many others surgical areas. This is multimodal, evidence-based approach program and includes simultaneous optimization of preoperative status of patients, adequate selection of surgical procedure and postoperative management. The aim of this program is to reduce complications, the length of hospital stay and to improve the patients outcome. Over the past decades, special attention was directed to the postoperative management in vascular surgery, especially after major vascular surgery because of the great risk of multiorgan failure, such as: respiratory failure, myocardial infarction, hemodynamic instability, coagulopathy, renal failure, neurological disorders, and intra-abdominal complications. Although a lot of effort was put into it, there is no unique acceptable program for ERAS in this surgical field, and there is still a need to point out the factors responsible for postoperative outcomes of these patients. So far, it is known that special attention should be paid to already existing diseases, type and the duration of the surgical intervention, hemodynamic and fluid management, nutrition, pain management, and early mobilization of patients.
Background
Quality of life is an important factor in the etiology and prognosis of coronary artery disease (CAD) as well as to evaluate effects of different interventions in cardiovascular diseases. Improvement in quality of life (QOL) is an important goal for patients (pts) participating in cardiac rehabilitation (CR).
Purpose
To examine whether women and men benefit equally from comprehensive CR in terms of QOL and exercise tolerance in pts with CAD.
Methods
We enrolled 1362 CAD patients (mean age 60.4±9.5 years). All patients participated in a comprehensive three weeks CR program at residential center and in all pts before and after CR exercise test was performed. Psychological dimensions were assessed at baseline and post-CR by validated questionnaire Short-Form 36 Health Status Survey (SF-36). All data were analyzed based on gender.
Results
Women participate in CR in lower percentage than man: 336 (24.7%) women vs 1026 (75.3%) men. Out of 1362 CAD pts, SF-36 was performed in 119 pts (75.6% men and 23.5% women). Before CR, physical function (PF), fatigue (F) and social functioning (SF) were significantly higher in men than in women (P<0.001; <0.05 and <0.01). After CR, scores of all domains of the SF-36 were significantly improved in all 119 pts (P<0.001). However, compared to the baseline, and based on gender, women had greater improvement than men in PF: 36.6%vs 11.4%, physical limitation (PL): 119.6 vs 52.2%, emotional well-being (EWB): 12.9% vs 7.5%, SF: 23% vs 4.9%, body pain (BP): 16.4%vs 4.9%, F: 14.3%vs 10.9% and health change (HC): 34%vs 17.9%. At the end of stationary CR there was no significant difference in domains of the SF-36 between men and women. At baseline men had significantly higher level and duration of exercise test than women (both P<0.001). After CR, level and duration of exercise test increased significantly in 1026 men ( by 12% and by 16.5%; both P<0,001), and 336 women (by 18% and by 21%; both P<0.001), and it was still higher in men than women after CR (both P<0.001).
Conclusions
Study demonstrated that women are generally less participate in CR than men. Results indicated that CR improve QOL in CAD pts, especially in women, which was expressed through higher improvement in PF, PL, EWB, SF,BP, F and HC than in men. Those positive changes in QOL were associated with significant improvement in exercise capacity in men as well as in women. CR needs to improve in referral and participation of women.
Funding Acknowledgement
Type of funding source: None
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.