Enhanced recovery after thoracic surgery: Clinical outcomes and imaging-based evaluation of a multimodal rehabilitation strategy

Enhanced recovery after surgery (ERAS) protocols are increasingly adopted in thoracic surgery to optimize recovery, but evidence integrating surgical outcomes with imaging-based postoperative recovery assessment remains limited, particularly for video-assisted thoracoscopic surgery. This single-center retrospective cohort study included patients undergoing elective video-assisted thoracoscopic surgery, divided into an ERAS group and a conventional care group. Outcomes analyzed included clinical indices (postoperative complications, chest tube duration, hospital stay), numerical rating scale pain scores, pulmonary function (forced expiratory volume in 1 second, forced vital capacity), health-related quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30), and imaging assessments (computed tomography for lung re-expansion rate, chest radiography for inflammatory resolution rate). Compared with the conventional group, the ERAS group had a significantly lower total postoperative complication rate (31.2% vs 71.9%, P < .01), with significantly fewer cases of atelectasis and pleural effusion. The ERAS group also had significantly shorter chest tube duration and postoperative hospital stay, better pain control (numeric rating scale scores at 1 or 3 days postoperatively, both P < .001), significantly superior pulmonary function at 1 week and 1 month, significantly higher 1 week lung re-expansion rate (89.2 ± 5.3% vs 72.6 ± 4.5%, P < .001) and 1 month inflammatory resolution rate (84.7 ± 5.9% vs 68.0 ± 5.6%, P < .001), and significantly improved 1 month European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 scores ( P < .001). A multimodal ERAS strategy significantly enhances postoperative outcomes in patients undergoing video-assisted thoracoscopic surgery. Imaging-based evaluation provides objective evidence of lung recovery, supporting its role as a valuable adjunct to clinical and functional assessments in thoracic surgical practice.