Patient-centred care in thoracic surgery: a holistic approach—A review of the subjects of enhanced recovery after surgery, rehabilitation, pain management and patient-reported outcome measures in thoracic surgery

Abstract

The symposium Patient-centered care in thoracic care: a holistic approach was held on June 22, 2021, as a virtual event in the context of the European conference on general thoracic surgery. Its aim was to explore how to improve patient outcomes in thoracic surgery by using enhanced recovery after surgery (ERAS®) frameworks and collaboration within healthcare. During the four presentations, topics on patient mobilization and physical rehabilitation, pain management, and the role of chest drainage in facilitating perioperative care were discussed. Strategies to minimize opioid consumption and incorporate patients' experiences as quality indicators were described. There were two main ideas that were considered pivotal to achieve optimal care: (I) the use of simple, easily implementable perioperative protocols and practices to improve compliance from both patients and the healthcare team, and (II) promote a better recovery with early mobilization and reducing the patient's levels of pain. Among the key learnings that emerged from the presentations are the importance of taking the patient's experiences into account, including what they value the most after surgery, and how technology can enable better care. The use of digital chest drainage systems emerged as a way for improving patient outcomes and experiences across several key indicators.

Would the width of a metal rib spreader affect postoperative pain in patients who undergo video-assisted mini-thoracotomy (VAMT)?

“…The common causes of perioperative pain in patients undergoing thoracic surgery include surgical trauma, placement of the indwelling drainage tube, pleural injury, intercostal nerve injury or compression, postural discomfort, and anxiety or tension, among other factors ( 24 ). Nociceptive stimulation caused by thoracic surgery, including that caused directly by the incision or subsequent release of inflammatory factors ( 25 ), can activate peripheral and central nervous system neurons leading to nociceptive sensitisation, which can then cause acute postoperative pain in patients.…”

Enhanced Recovery after Surgery (ERAS) in der Thoraxchirurgie

“…Viele der in der umfangreichen Leitlinie aufgeführten Items zielen auf vier in verschiedenen ERAS-Programmen immer wiederkehrende inhaltliche Kernpunkte ab [10] ERAS-Programme werden als patientenzentrierter Ansatz verstanden, der eine schnellstmögliche Erholung und Rückkehr in ein selbstversorgtes Umfeld nach (thorax-)chirurgischen Eingriffen ermöglichen soll [13]. Daher rücken die Erfahrungen, die Patient*innen während des Krankhausaufenthaltes machen, als mögliche Outcome-Parameter ("patient-reported outcome measures", PROMs) mehr in den Vordergrund.…”

Protocol for a randomised controlled trial: optimisation of perioperative analgesia protocol for uniportal video-assisted thoracoscopic surgery

“…Postoperative thoracic pain can affect active coughing and early mobilisation, which can impair sputum clearance and increase the risk of atelectasis and thrombotic events. Optimal perioperative pain management in thoracic surgery includes a minimally invasive incision, multimodal analgesia, regional analgesia, minimal opioid utilisation, and effective chest drainage 2–4…”

“…Optimal perioperative pain management in thoracic surgery includes a minimally invasive incision, multimodal analgesia, regional analgesia, minimal opioid utilisation, and effective chest drainage. 2–4 …”

“…Optimal perioperative pain management in thoracic surgery includes a minimally invasive incision, multimodal analgesia, regional analgesia, minimal opioid utilisation, and effective chest drainage. [2][3][4] Based on the strategy for multimodal analgesia, recent research has explored various methods to alleviate pain after thoracic surgery. In 2022, the PROSPECT guidelines proved that among several alternative nerve block methods, single-shot erector spinae plane block (ESPB) and single-shot paravertebral block (PVB) offer superior analgesic effect on video-assisted thoracoscopic…”