F-105enhanced Recovery After Thoracic Surgery: Outcomes Following Implementation of a Tailored Eras Pathway in a Tertiary Centre

Objectives: Minimally-invasive video-assisted thoracoscopic surgery (VATS) and evolution of pulmonary rehabilitation services have enabled ERAS principles to be applied to thoracic surgery, aiming to reduce postoperative recovery time and complications. We present our tailored, multidisciplinary ERAS protocol and results for patients undergoing lung resection in a large, tertiary-level centre. Methods: Retrospective case-note analysis of 60 consecutive anatomical lung resections performed before and after implementation of our ERAS protocol (30 patients in each cohort) during the periods March–May 2014 and July–August 2014. A total of 32 key variables were analysed in 3 groups: preoperative optimization (e.g. smoking cessation, carbohydrate loading, benzodiazepine avoidance), intraoperative factors (minimally-invasive technique, regional anaesthesia), postoperative outcomes (analgesia, complications, readmission). Results: No significant difference in median age, surgical indication or staging was found between the cohorts. Compliance with ERAS preoperative measures was strong; in particular, the use of benzodiazepine sedation fell significantly (36.7% to 3.3%, P = 0.001). Patients admitted on the day of surgery rose (6.7% to 73.3%, P < 0.001). Minimally-invasive surgery has doubled to 53.3%, and we have moved completely from epidural to regional anaesthesia with paravertebral and intercostal blocks (23.3% to 86.7%, P < 0.001). Postoperative chest infection rates almost halved (30% to 16.7%), as did cardiovascular complications (AF/DVT/PE) (13.3% to 6.7%) whilst constipation rate fell from 36.7% to 10% (P = 0.014). Readmission to level-3 care was markedly reduced (10% to 0%). Median length of stay (LOS) with ERAS was 5 days, lower than the historical departmental LOS of 8 days. Notably, a reduction of LOS by 1 day was found following pneumonectomy (6 to 5 days). Conclusions: Our results demonstrate that ERAS principles can be applied to thoracic surgery patients with great success. Most common and major postoperative complications have been reduced with a resulting decrease in postoperative length of stay. Disclosure: No significant relationships.