Efficacy of the Enhanced Recovery After Surgery program for thoracic surgery in a developing country

Abstract

Purpose Enhanced Recovery After Surgery (ERAS) is a strategy used to improve perioperative outcomes and reduce complications. However, data on the efficacy of ERAS in thoracic surgery in developing countries are limited. The current study aimed to validate the benefits of ERAS among patients at a single institution. Methods This was a retrospective study of patients who underwent pulmonary resection at Vajira Hospital, Bangkok, Thailand, between 2016 and 2020. To compare outcomes, patients were divided into the pre-ERAS group (2016–2018) and the post-ERAS group (2019–2020) using propensity score matching (1:2) with the year 2019 as the cutoff for introducing ERAS protocols at our institution. Results In total, 321 patients were included in the analysis (pre-ERAS group, n = 74; post-ERAS group, n = 247). After propensity score matching, 56 and 112 patients were classified under the pre- and post-ERAS groups, respectively. The post-ERAS group had significantly lower pain scores than the pre-ERAS group on postoperative days 1, 2, and 3, and a lower volume of intraoperative blood loss. In the multivariable analysis, the post-ERAS group had a shorter chest tube duration (mean difference = −1.62 days, 95% confidence interval = −2.65 to −0.31) and length of hospital stay (mean difference = −2.40 days, 95% confidence interval = −4.45 to −0.65) than the pre-ERAS group. Conclusion The use of ERAS guidelines in pulmonary resection is beneficial. Although no significant differences were observed in postoperative complication rate, intensive care unit stay, and additional cost burden between the two groups, patients in the post-ERAS group had a shorter postoperative chest tube duration, shorter hospital stays, shorter operative time, lower postoperative pain score, and lower volume of intraoperative blood loss.

Outcomes of mobilization in the first hour following uniportal video-assisted thoracoscopic surgery for primary spontaneous pneumothorax

“…Prolonged immobilization increases bronchial secretions; increases the risk of atelectasis, pulmonary infection, and thromboembolism; prolongs hospitalization; and reduces patient self-confidence [ 5 ]. Mobilization and active participation of patients were important to optimize analgesia and improve postoperative outcomes [ 4 , 17 , 18 ]. Early discontinuation of bed rest and mobility improved pain control and increased the efficacy of cough and secretion clearance [ 5 ].…”

“…Various analgesic agents and procedures have been used to control severe pain and agitation after extubation. Although some authors suggest peripheral locoregional analgesia (paravertebral block, serratus plane block, and intercostal block), paravertebral or epidural blocks were not performed to facilitate mobilization [ 7 , 17 ]. The side effects of opioids include somnolence, hypotension, and postoperative nausea and vomiting [ 20 ].…”

Does Enhanced Recovery After Surgery Protocols Reduce Complications and Length of Stay After Thoracic Surgery: A Systematic Review of the Literature

“…There is significant variation in the included observational trials regarding sample size (range of 83 to 10,021 patients), hypothesis (ERAS vs historical control; impact of compliance with ERAS and outcomes), and design (prospective with matched historical controls, entirely retrospective). Of the included 26 observational trials, 21 reported the effect of ERAS on overall complications, with seven studies demonstrating that implementation of an ERAS protocol led to reduced overall post-operative morbidity [3,6,[9][10][11][12]14,15,[18][19][20][21]23,[25][26][27]28,29,[30][31][32]. Five of these studies were comparing the ERAS protocol to historical controls [3,9,10,11,31].…”

“…Of the 26 included studies, 14 reported on mortality [12,13,16,18,19,22,23,26,27,29,[30][31][32]. The only study to report a significant difference in mortality was the study by Alwarti et al, a retrospective cohort study published in 2021 [13].…”

Enhanced recovery after elective spinal surgery: an Australian pilot study

“…As such, the ERASÒ society ( www.erassociety.org ) has developed evidence driven guidelines for the successful implementation and audit of these perioperative pathways in various specialties. Although its roots began in colorectal surgery multiple surgical fields such as cardiothoracic ( 3 ), gynaecology ( 4 ) and orthopaedic joint surgery ( 5 ) have applied speciality-specific protocols with published successes over the last decade. More recently its implementation and assessment has been adopted to spine surgery across the world, but in Australia it still remains in its infancy.…”