G. J. Haro1, D. M. Jablons1, J. R. Kratz1 1University Of California – San Francisco,San Francisco, CA, USA
Introduction:
Enhanced recovery after thoracic surgery (ERATS) programs have not been widely utilized but have the potential to improve perioperative outcomes. We developed an evidence-based, multidisciplinary ERATS program for our lung resection patients in an academic, quaternary-care center. In this study, we evaluate our outcomes following ERATS implementation.
Methods:
The ERATS program was implemented in October 2017 and included preoperative education, increased utilization of minimally invasive surgery, and standardization of anesthesia techniques, hospital acuity, ancillary consultations, line management, and multimodality analgesia. Patients were included in the study if they underwent elective lobectomy or sublobar resection by any technique for primary or secondary lung cancer from October 2015 to June 2018, which included two years before and nine months after the program. Propensity scores based upon age, sex, race, comorbidity, diagnosis, technique (minimally invasive versus thoracotomy), and procedure were used to match patients and evaluate outcomes.
Results:
156 pre-ERATS and 65 post-ERATS patients were consecutively identified. There were no substantial differences in age, sex, race, comorbidity, smoking history, or diagnosis, but there were slightly more lobectomies performed post-ERATS (Pre 44.9%-Post 53.9%). Regarding adherence to the program, the proportion of minimally invasive cases increased by 21.0%, and the number of patients admitted to the ICU was reduced by 47.3%. Foley catheters and chest tubes were removed 56.9% and 60.0% within goal, respectively, and the number of patients that ambulated at least three times on POD1 remained the same (Pre 66.0%-Post 63.1%). In propensity score matched analysis that accounted for minimally invasive surgery (Table), the program was estimated to reduce length of stay by 1.1 days (95% CI 0.3-2.0; P=0.01), morbidity by 14.5% (95% CI 2.9%-30.3%; P=0.02), and the direct costs of surgery and hospitalization by $5,000 (95% CI $2,000-7,900; P<0.01). Despite expedited hospitalizations, readmission remained minimal (Pre 5.1%-Post 1.5%; P=0.39).
Conclusion:
Our early experience displays that an ERATS program for lung resection reduces length of stay, morbidity, and direct costs without an increase in readmission. Application of an ERATS program to other thoracic resections, such as esophagectomy or mediastinal mass resection, may show similar benefit
