Enhanced recovery programs in lung cancer surgery: systematic review and meta-analysis of randomized controlled trials

Abstract

BackgroundEnhanced recovery after surgery (ERAS) program is an effective evidence-based multidisciplinary protocol of perioperative care, but its roles in thoracic surgery remain unclear. This systematic review of randomized controlled trials (RCTs) aims to investigate the efficacy and safety of the ERAS programs for lung cancer surgery.Materials and methodsWe searched the PubMed and EMBASE databases to identify the RCTs that implemented an ERAS program encompassing more than four care elements within at least two phases of perioperative care in lung cancer surgery. The heterogeneity levels between studies were estimated by the Cochrane Collaborations. A qualitative review was performed if considerable heterogeneity was revealed. Relative risk (RR) and weighted mean difference served as the summarized statistics for the meta-analyses. Additional analyses were also performed to perceive potential bias risks.ResultsA total of seven RCTs enrolling 486 patients were included. The meta-analysis indicated that the ERAS group patients had significantly lower morbidity rates (RR=0.64; p<0.001), especially the rates of pulmonary (RR=0.43; p<0.001) and surgical complications (RR=0.46; p=0.010), than those of control group patients. No significant reduction was found in the in-hospital mortality (RR=0.70; p=0.58) or cardiovascular complications (RR=1.46; p=0.25). In the qualitative review, most of the evidence reported significantly shortened length of hospital and intensive care unit stay and decreased hospitalization costs in the ERAS-treated patients. No significant publication bias was detected in the meta-analyses.ConclusionOur review demonstrates that the implementation of an ERAS program for lung cancer surgery can effectively accelerate postoperative recovery and save hospitalization costs without compromising patients’ safety. A worldwide consensus guideline is urgently required to standardize the ERAS protocols for elective lung resections in the future.

Incentive Spirometry After Lung Resection: A Randomized Controlled Trial

“…We believe that this trial provides sound scientific impetus for abandoning the use of IS in the era of modern thoracic surgery. With the rise of minimally invasive surgery and Enhanced Recovery Pathways After Surgery protocols, a significant emphasis is being placed on eliminating redundant interventions in the postoperative setting [14]. A similar emphasis is also being placed on maximizing the value of medical care, by decreasing costs and improving quality.…”

Anaesthesia management for bronchoscopic and surgical lung volume reduction

“…Lung protective ventilation has become an integral part of protocols to prevent pulmonary complications like pneumonia or accelerate the recovery time [e.g., enhanced recovery after surgery (ERAS)], which is both also, wanted in LVR (23)(24)(25).…”

“…Strong evidence exists for a normovolemic fluid regimen in thoracic surgery ( Table 2). Balanced crystalloids are recommended, saline solutions should be avoided and colloids should only be used as a substitute for blood loss (23,25).…”

Enhanced recovery after surgery (ERAS) pathway for primary hip and knee arthroplasty: study protocol for a randomized controlled trial

“…Enhanced recovery after surgery (ERAS) is proposed as a series of evidence-based perioperative optimizations with multidisciplinary approach to reduce surgical stress and accelerate postoperative recovery [2]. Following the general guidelines, different ERAS pathways have been reported to reduce the morbidities, save cost, promote faster recovery, and achieve the clinical and economic gain in colorectal [3], thoracic [4], and orthopedic surgeries [5]. Regional anesthesia is recommended for ERAS because it provides reliable analgesia and little disturbance on hemodynamics in published literatures [2,3,4,6].…”

“…Following the general guidelines, different ERAS pathways have been reported to reduce the morbidities, save cost, promote faster recovery, and achieve the clinical and economic gain in colorectal [3], thoracic [4], and orthopedic surgeries [5]. Regional anesthesia is recommended for ERAS because it provides reliable analgesia and little disturbance on hemodynamics in published literatures [2,3,4,6]. However, for patients undergoing THA and TKA, spinal anesthesia is frequently associated with prolonged indwelling urinary catheter [7], and furthermore, the peripheral nerve block may weaken the lower limb muscle strength, leading to delayed mobilization [8].…”