Enhanced Recovery Decreases Pulmonary and Cardiac Complications After Thoracotomy for Lung Cancer

Abstract

ERAS was associated with improved postoperative outcomes, including decreased length of stay and pulmonary and cardiac morbidity after thoracotomy, but not after minimally invasive operations. ERAS safety was demonstrated by low rates of adverse events without effect on hospital readmission or perioperative deaths.

Enhanced Recovery after Thoracic Surgery

“…There are now hundreds of publications about the use of ERP in thoracic practice. Early adopters at McGill, 16 MD Anderson, 12,17 University of Virginia, 6 St. James Hospital in Bristol, United Kingdom, 15 and Leeds Hospital 18 are comprehensively reviewed in a 2018 article that compares step-bystep components of each program. 19 There is considerable variability in the components of each program, and thus the outcomes vary substantially as well.…”

“…The MD Anderson group was able to show a significant decrease in pulmonary (29 vs. 20%, p < 0.01) and cardiac (18 vs. 12%, p < 0.01) pre-and post-ERP complications in thoracotomy patients. 17 Many publications are from early experience with ERP, and with continuous process improvement, it is expected that complications and readmission rates will be positively impacted.…”

Commentary: Predicting patients at risk for complications after thoracic surgery—Application in the era of enhanced recovery

“…6 This timing is of particular interest, given the heightened emphasis in our field on enhanced recovery pathways after thoracic surgery, many of which have led to expedited hospital discharge. 8,9 While Amar and colleagues 6 have made an excellent recommendation that patients at high risk for atrial fibrillation may need prophylaxis, one must also consider that patients treated under enhanced recovery protocols may potentially be discharged before their development of atrial fibrillation. Thus, another important use for this nomogram may be in alerting practitioners of patients at risk to help guide decisions regarding appropriateness of early discharge.…”

“…Thus, another important use for this nomogram may be in alerting practitioners of patients at risk to help guide decisions regarding appropriateness of early discharge. However, somewhat complicating the picture, evidence from Van Haren and associates 9 has shown a reduction in postoperative cardiac complications (including atrial fibrillation) from 18% to 12% following the implementation of an enhanced recovery program. Therefore, while nomograms such as that developed by Amar and colleagues 6 may prove useful in avoiding early discharge of patients at high risk for atrial fibrillation, it is not clear that the probability of atrial fibrillation is equivalent among patients treated under enhanced recovery pathways.…”

Commentary: Video-assisted thoracic surgery in the era of enhanced recovery after surgery—does good perioperative care trump good surgery?

“…This mirrors the findings of other centers, where patients who undergo thoracotomy appear to have the most to gain from ERAS. 5 So why is there so little to choose between the 2 surgical approaches in this study? One reason is that it is underpowered, with relatively small patient numbers in each group (VATS 71, open 59).…”