Enhanced recovery after surgery pathway leads to decreased length of stay for patients undergoing minimally invasive lung resection

Madeline L Fryer; Benjamin A Palleiko; Isabel Emmerick; Allison Crawford; Mamatha Kadiyala; Feiran Lou; Karl Uy; Mark W Maxfield

doi:10.21037/jtd-23-1500

Enhanced recovery after surgery pathway leads to decreased length of stay for patients undergoing minimally invasive lung resection

J Thorac Dis. 2024 Feb 29;16(2):1324-1337. doi: 10.21037/jtd-23-1500. Epub 2024 Feb 26.

Authors

Madeline L Fryer¹, Benjamin A Palleiko¹, Isabel Emmerick¹, Allison Crawford¹, Mamatha Kadiyala², Feiran Lou¹, Karl Uy¹, Mark W Maxfield¹

Affiliations

¹ Department of Surgery, UMass Chan Medical School, Worcester, MA, USA.
² Department of Anesthesiology, UMass Chan Medical School, Worcester, MA, USA.

Abstract

Background: Enhanced recovery after surgery (ERAS) protocols in thoracic surgery have been demonstrated to impact length of stay (LOS), complication rates, and postoperative opioid use. However, ERAS protocols for minimally invasive lung resections have not been well described. Given most lung resections are now performed minimally invasively, there is a gap in the literature regarding the efficacy of ERAS protocols in this setting. In this study, we analyzed patient outcomes following implementation of an ERAS protocol for minimally invasive lung resections.

Methods: Outcome data was retrospectively collected for 442 patients undergoing minimally invasive lung resections between January 1^st, 2015 and October 26^th, 2021. Patients were divided into either a pre-ERAS (n=193) or ERAS (n=249) group. Primary outcomes included LOS, postoperative complications, intensive care unit (ICU) admission status, 30-day hospital readmissions, and 30-day mortality. Secondary outcomes included common postoperative complications required for the Society for Thoracic Surgeons (STS) database.

Results: We observed an overall decrease in median LOS (4.0 vs. 3.0 days, P=0.030) and ICU admission status (15% vs. 7.6%, P=0.020) after implementation of our ERAS protocol. The difference in LOS was significantly lower for anatomic lung resections, but not non-anatomic resections. There was no difference in 30-day readmissions and a 0% mortality rate in both groups. Overall, there was a low complication rate that was similar between groups.

Conclusions: The implementation of an ERAS protocol led to decreased LOS and decreased ICU admission in patients undergoing minimally invasive lung resection. Process standardization optimizes performance by providers by decreasing decision fatigue and improving decision making, which may contribute to the improved outcomes observed in this study.

Keywords: Thoracic surgery; enhanced recovery after surgery (ERAS); fast track; minimally invasive lung resection; outcomes.