Enhanced Recovery After Surgery (ERAS) in Minimal Thoracic Surgery: The magic combo

Objective: Enhanced Recovery After Surgery (ERAS) protocol is an evidence-based interdisciplinary, patient centered healthcare pathway, that encompass preoperative, intraoperative, and postoperative healthcare steps, in order to improve patients’ outcome. The implementation of this protocol in Minimal Invasive Thoracic Surgery has an impact in reducing hospital length of stay (LOS) and postoperative complication rates, while patient experience reduction of physiologic stress, and early return to normal function.

Methods: This is a retrospective analysis of three hundred patients who underwent minimal invasive thoracic surgery for lobectomy or bilobectomy by our surgical team, from January 2019 until December 2023. We analyzed demographic data and patients’ characteristics with the implementation of ERAS protocol (adjusted in localized practice). The primary outcomes were mortality and hospital length of stay. Secondary outcomes were readmission rate and admission in Intensive Care Unit.

Results: Three hundred patients with mean age 66,83 years underwent video and robotic assisted lobectomy and Bilobectomy. The percentage of lung malignancies was 99% and the in-hospital and 30-day mortality percentage was zero. The mean hospital length of stay was 3,41 (± 2,27) and the readmission rete was <1%. There was also an observed significant decrease in opioid medication doses.

Conclusions: The implementation of Enhanced Recovery After Surgery Protocol in Minimal Thoracic Surgery, even adjusted to local practice, offers the optimal treatment to the patient. Early discharge, eliminated mortality and readmission rate and improved patient satisfaction are only some of the benefits.

Enhanced Recovery After Surgery (ERAS) protocol is an evidence-based interdisciplinary, patient centered healthcare pathway, that encompass preoperative, intraoperative, and postoperative healthcare steps, in order to improve patients’ outcome.ERAS main objective is to minimize stress response and surgical trauma. Subsequently there is a decrease in hospital stay and hospital costs.ERAS pathway encompasses the multidisciplinary collaboration and involves patients with empowerment and communication.

Minimally Invasive Thoracic Surgery (MITS) aims to reduce physiologic stress and surgical trauma, reduce postoperative complication rates, reduce length of hospital stay early return to return to normal function. MITS includes Video Assisted Thoracic Surgery (VATS) and Robotic Assisted Thoracic Surgery (RATS). MITS and early mobilization of the patient appear to be more influential in ERAS protocol.

The Key Components of ERAS are: