Systematic review of the influence of enhanced recovery pathways in elective lung resection

Fiore, Julio F.; Bejjani, Jimmy; K, Conrad; Niculiseanu, Petru; Landry, Tara; Lee, Lawrence; Ferri, Lorenzo; Feldman, Liane S.

doi:10.1016/j.jtcvs.2015.09.112

Cited by 107 publications

(99 citation statements)

References 24 publications

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“…We previously reported the results of a retrospective comparison of clinical outcomes of open lung resection for patients treated with an ERP compared with traditional care [10], which included patients from the present prospective study. Similar to this previous study and consistent with existing literature [3,11], we found that patients in the ERP group had shorter median duration of hospitalization and fewer overall complications. The lower overall complication rate was driven by lower rates of urinary tract infections, which may be related to removal of the urinary catheter on postoperative day 1, even in the presence of a thoracic epidural [22].…”

Section: Commentsupporting

confidence: 93%

“…In a variety of surgical procedures, ERPs are associated with reductions in hospital stay, complications, and costs [3][4][5]. The evidence suggests a promising role for ERPs to improve clinical outcomes in lung resections [10], but information is lacking about their economic effect, particularly after primary hospitalization [9,11,12]. We found that compared with CC, introduction of an ERP was associated with shorter hospital length of stay, fewer complications, and lower societal costs.…”

Section: Commentmentioning

confidence: 96%

“…We and others have demonstrated the utility of ERPs for lung resection [6][7][8][9][10]. However, although a recent systematic review reported that ERPs might reduce length of stay and hospitalization costs for patients undergoing lung resection, the quality of the included studies was low [11]. Moreover, costs were reported from the hospital perspective [9,12], which is highly influenced by the length of the primary hospitalization; however, no studies investigated the postdischarge socioeconomic effect of ERPs for lung resection, including subsequent health care system utilization and caregiver burden.…”

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confidence: 99%

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Economic Impact of an Enhanced Recovery Pathway for Lung Resection

Paci

Madani

Lee

et al. 2017

The Annals of Thoracic Surgery

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Section: Commentsupporting

confidence: 93%

Section: Commentmentioning

confidence: 96%

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confidence: 99%

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Economic Impact of an Enhanced Recovery Pathway for Lung Resection

Paci

Madani

Lee

et al. 2017

The Annals of Thoracic Surgery

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“…A systematic review by Fiore and colleagues only identified six studies involving lung resections, and only one of them was a randomized trial defining fast track protocols and analyzing outcomes (18). The incidence of postoperative complications with the use of ERAS was reduced in one of the three studies.…”

Section: Eras and Vats Lobectomy: What Is The Evidence?mentioning

confidence: 99%

A comprehensive protocol for physiokinesis therapy and enhanced recovery after surgery in patients undergoing video-assisted thoracoscopic surgery lobectomy

Bertani¹,

Ferrari²,

Terzo³

et al. 2018

J. Thorac. Dis.

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Background: Video-assisted thoracoscopic surgery (VATS) lobectomy has recently been adopted as the gold standard surgical option for the treatment of early stage non-small cell lung cancer. Enhanced recovery after surgery (ERAS) is being progressively adopted in thoracic surgery to improve the postoperative outcomes. Even if the benefits of ERAS are universally accepted, to date a standardized and uniform approach has not been described in the medical literature. The Italian VATS group has recently proposed to include in the VATS lobectomy database a structured protocol for ERAS. Methods:The ERAS section of the Italian VATS group is proposing a comprehensive ERAS protocol within the VATS lobectomy database, allowing the prospective collection of a dedicated set of data. Separate sections of the protocol are dedicated to different topics of ERAS. This study is specifically dedicated to the section of physiokinesis therapy. The medical literature will be extensively reviewed and a physiotherapy (PT) protocol of ERAS will be presented and discussed. A seta of structured clinical pathways will also be suggested for adoption in the VATS Group database.Discussion: Pre-and post-operative adoption of an ERAS protocol in patients undergoing VATS lobectomy may promote an improved post-operative course, a shorter hospital stay and an overall more comfortable patients' experience. The mainstays of a physiokinesis therapy ERAS protocol are patients' education, constant physical and respiratory therapy sessions, and adoption of adequate devices. Although many studies have investigated the usefulness of physical and respiratory physiokinesis therapy, a comprehensive ERAS protocol for VATS lobectomy patients has not yet been described. The proposed ERAS platform, adopted by the VATS Group database, will contribute to a prospective data collection and allow a scientific analysis of the results.

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“…Among the modifiable factors, the most relevant were the management of chest tubes, pain control, and social support plans. In spite of the factors contributing to ERP are well embedded in the thoracic surgery practice, the literature on ERP in our specialty is scant (5). Only few studies tried to analyze the effect of a standardized practice on the outcome after lung surgery.…”

mentioning

confidence: 99%

Enhanced recovery pathways version 2.0 in thoracic surgery

Brunelli¹,

Imperatori²,

Droghetti³

2018

J. Thorac. Dis.

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Enhanced recovery pathways (ERPs) after surgery is a multimodal plan of care based on the application of multiple standardized evidence-based elements with the aim to improve the perioperative patient experience and surgical outcomes. These standardized elements are not just limited to the postoperative period but refer to the preoperative phase and obviously the surgical procedure. ERP is based on the concept of "marginal gains", well known in sport. Applied in isolation, the individual elements may have not a great effect on the outcome, but when applied together they act synergistically (1).The concept of ERP has been popularized in other specialties, particularly colorectal surgery, in which this practice has shown great benefits compared to standard care (2).However, thoracic surgeons are used to the elements of ERP, even though these were not badged as such. Certain practices, such as fluid balance, pain management, early mobilization, postoperative rehabilitation, are used in many thoracic surgery centers since decades. Several years ago, Cerfolio and colleagues (3,4) for instance identified modifiable and non-modifiable factors, which could contribute to improve fast track rate. Among the modifiable factors, the most relevant were the management of chest tubes, pain control, and social support plans. In spite of the factors contributing to ERP are well embedded in the thoracic surgery practice, the literature on ERP in our specialty is scant (5). Only few studies tried to analyze the effect of a standardized practice on the outcome after lung surgery. These studies were inconsistent in the elements they used to define a fast track protocol. The findings were also inconsistent. In general, the application of standardized elements of care contributed to reduce hospital stay. However, inconsistent findings were reported in terms of morbidity, mortality and re-admission rates (6-8).In all specialties, minimally invasive surgery represents the most important element in an ERP program. Yet so far most of the studies in thoracic surgery failed to include patients submitted to video-assisted thoracoscopic surgery (VATS), mostly because they were conducted prior to the widespread use of this approach.In a recent study, we were not able to find any difference in terms of morbidity, mortality and length of stay between patients submitted to VATS lobectomy before and after the introduction of a formal ERP program at our institution (9). The most likely explanation for this rather disappointing finding is that the majority of the key elements, which constitute ERP were already in place before the start of a formal ERP (i.e., use of a single drain, use of a digital drain system, similar pain management, postoperative rehabilitation, early oral feeding, etc.). The addition of few other elements such as the assumption of energy drinks before surgery to reduce the catabolic response or the use of warming blanket to prevent shivering and hypothermia among the others are unlikely to provide any benefits in a population who...

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Systematic review of the influence of enhanced recovery pathways in elective lung resection

Cited by 107 publications

References 24 publications

Economic Impact of an Enhanced Recovery Pathway for Lung Resection

Economic Impact of an Enhanced Recovery Pathway for Lung Resection

A comprehensive protocol for physiokinesis therapy and enhanced recovery after surgery in patients undergoing video-assisted thoracoscopic surgery lobectomy

Enhanced recovery pathways version 2.0 in thoracic surgery

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