Enhanced recovery pathways in thoracic surgery: the Quebec experience

Hubert, J.; Bourdages-Pageau, Etienne; Garneau, Charles Antoine Paradis; Labbé, Catherine; Ugalde, Paula A.

doi:10.21037/jtd.2018.01.156

Cited by 17 publications

(12 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Rapid diagnostic assessment programs (DAPs) and enhanced recovery protocols (ERPs) may improve timeliness of surgical care [ 3 ]. Dr. Hubert and colleagues reported that using the DAP, the median time between the patient’s first clinic visit and referral to surgery was 30 days, and the median time between surgical consult and treatment was 29 days [ 24 ]. To date, there is no consensus whether a longer preoperative delay has a negative effect on overall survival.…”

Section: Discussionmentioning

confidence: 99%

The Impact of COVID-19 on the Diagnosis and Treatment of Lung Cancer at a Canadian Academic Center: A Retrospective Chart Review

et al. 2021

View full text Add to dashboard Cite

The large burden of COVID-19 on health care systems worldwide has raised concerns among medical oncologists about the impact of COVID-19 on the diagnosis and treatment of lung cancer patients. In this retrospective cohort study, we investigated the impact of COVID-19 on lung cancer diagnosis and treatment before and during the COVID-19 era. New lung cancer diagnoses decreased by 34.7% during the pandemic with slightly more advanced stages of disease, there was a significant increase in the utilization of radiosurgery as the first definitive treatment, and a decrease in both systemic treatment as well as surgery compared to the pre-COVID-19 era. There was no significant delay in starting chemotherapy and radiation treatment during the pandemic compared to pre-COVID-19 time. However, we observed a delay to lung cancer surgery during the pandemic time. COVID-19 seems to have had a major impact at our lung cancer center on the diagnoses and treatment patterns of lung cancer patients. Many oncologists fear that they will see an increase in newly diagnosed lung cancer patients in the coming year. This study is still ongoing and further data will be collected and analyzed to better understand the total impact of the COVID-19 pandemic on our lung cancer patient population.

show abstract

Section: Discussionmentioning

confidence: 99%

The Impact of COVID-19 on the Diagnosis and Treatment of Lung Cancer at a Canadian Academic Center: A Retrospective Chart Review

et al. 2021

View full text Add to dashboard Cite

show abstract

“…[ 8 ] Regarding thoracic surgery, there are different comparable ERATS protocols (with similar, but not the same recommendations) developed from different centers in different countries. [ 9 10 11 12 13 14 15 16 17 ] The Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS) have subsequently developed an international “formal” consensus on ERATS. [ 15 ]…”

Section: Introductionmentioning

confidence: 99%

Enhanced recovery after thoracic anesthesia

Şentürk

Sungur

2021

Saudi Journal of Anaesthesia

View full text Add to dashboard Cite

In recent years, the concept of “Perioperative Medicine” has been evolved to a more concrete and sophisticated approach called “Enhanced Recovery After Surgery” (ERAS). ERAS has been first introduced in colorectal surgery by a dedicated leading ERAS® society, ERAS-criteria has been subsequently extended into several types of surgery, including thoracic surgery. Anesthesiology has always been one of the most important components of the multidisciplinary perioperative approaches, which is also valid for ERAS. There are several guidelines published on the enhanced recovery after thoracic surgery (ERATS). This article focuses on the “official” ERATS protocols of a joint consensus of two different societies. Regarding thoracic anesthesia, there are some challenges to be dealt with. The first challenge, although there is a large number of studies published on thoracic anesthesia, only a very few of them have studied the overall outcome and quality of recovery; and only few of them were powered enough to provide sufficient evidence. This has led to the fact that some components of the protocol are debatable. The second challenge, the adherence to individual elements and the overall compliance are poorly reported and also hard to apply even in the best organized centers. This article explains and discusses the debatable viewpoints on the elements of the ERATS protocol published in 2019 aiming to achieve a list for the future steps required for a more effective and evidence-based ERATS protocol.

show abstract

“…Immediately upon arrival to the PACU an attempt is made to move the patient from the stretcher to the chair. This is a marked difference from published ERAS protocols for thoracic surgery; in fact, we were able to find only a single program which reported a goal of mobilization to a chair prior to four hours post-surgery (8). If this is deemed unsafe by nursing staff, (e.g., if the patient is unable to mentate or the vitals are tenuous) then an attempt is made every 3-5 minutes thereafter.…”

Section: Pacumentioning

confidence: 80%

“…Additional challenges unique to thoracic surgery include the physiologic insult caused by one lung ventilation intraoperatively and pain from intercostal incisions limiting respiratory effort. There are currently no consensus guidelines from the ERAS group for general thoracic surgery; however, several groups have published their initial experiences with enhanced recovery protocols (3)(4)(5)(6)(7)(8)(9)(10). Common elements include preoperative optimization with smoking cessation and preoperative exercise regimens, intraoperative care modifications with a focus on minimally invasive techniques, drain limitation, and long term narcotic avoidance.…”

Section: Introductionmentioning

confidence: 99%

“…In particular, the post-operative "early mobility" goal is a generalized encouragement of mobility with no report of a quantitative assessment. Some institutions have a goal of mobilization to a chair on the operative or first post-operative day (7,8,10) while others have ambulation as the goal, anywhere from the first post-operative day (4,6,12) to the day of surgery (3,13).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Implementing a thoracic enhanced recovery with ambulation after surgery program: key aspects and challenges

Mayor¹,

Khandhar²,

Chandy³

et al. 2018

J. Thorac. Dis

View full text Add to dashboard Cite

Enhanced recovery after surgery (ERAS) protocols aim to improve operative outcomes by focusing on perioperative care, including early mobilization, limitation of narcotics, and maintenance of fluid balance. We implemented a T-ERA A S (Thoracic-Early Recovery with Ambulation After Surgery) protocol which focused on early ambulation, with the rationale that a patient's mobility may be a reproducible and measurable metric for their overall status-pain control, respiratory function, cardiac function, and patient satisfaction. We set a benchmark distance of 250 feet for our early ambulation goal and redefined "early" as within the first hour post extubation. We describe some of the major aspects to our program as well as some of the challenges and successes during our 8-year experience following the implementation of this program.

show abstract

Enhanced recovery pathways in thoracic surgery: the Quebec experience

Cited by 17 publications

References 21 publications

The Impact of COVID-19 on the Diagnosis and Treatment of Lung Cancer at a Canadian Academic Center: A Retrospective Chart Review

The Impact of COVID-19 on the Diagnosis and Treatment of Lung Cancer at a Canadian Academic Center: A Retrospective Chart Review

Enhanced recovery after thoracic anesthesia

Implementing a thoracic enhanced recovery with ambulation after surgery program: key aspects and challenges

Contact Info

Product

Resources

About