Evaluation of an enhanced recovery after lung surgery (ERALS) program in lung cancer lobectomy: An eight-year experience |
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| Affiliation: | 1. Servicio de Anestesiología y Reanimación, Unidad de Gestión Clínica Bloque Quirúrgico Hospital General, Hospital Universitario Virgen del Rocío, Avda Manuel Siurot s/n, Sevilla 41013, Spain;3. Servicio de Cirugía Torácica, Unidad Médico-Quirúrgica de enfermedades respiratorias, Hospital Universitario Virgen del Rocío, Avda Manuel Siurot s/n, Sevilla 41013, Spain;1. Unidad de Mama, Servicio de Cirugía General, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España;2. Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Cantabria, España;3. Departamento de Medicina y Cirugía, Universidad de Cantabria, Santander, Cantabria, España;4. Gestión de Atención Primaria, Servicio Cántabro de Salud, Santander, Cantabria, España;1. Servicio de Cirugía General y Digestiva, Hospital Universitario La Zarzuela, Madrid, España;2. Servicio de Radiodiagnóstico, Hospital Universitario La Zarzuela, Madrid, España;1. Unidad de Cirugía Endocrina, Servicio de Cirugía General, Hospital Clínico Universitario Virgen de la Arrixaca. Instituto Murciano de Investigaciones Biosanitarias (IMIB), Murcia, España;2. Unidad de Cirugía Pancreática, Servicio de Cirugía General, Hospital Clínico Universitario Virgen de la Arrixaca. Instituto Murciano de Investigaciones Biosanitarias (IMIB), Murcia, España |
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| Abstract: | IntroductionEnhanced recovery after lung surgery (ERALS) protocols have proven useful in reducing postoperative stay (POS) and postoperative complications (POC). We studied the performance of an ERALS program for lung cancer lobectomy in our institution, aiming to identify which factors are associated with a reduction of POC and POS.MethodsAnalytic retrospective observational study conducted in a tertiary care teaching hospital involving patients submitted to lobectomy for lung cancer and included in an ERALS program. Univariable and multivariable analysis were employed to identify factors associated with increased risk of POC and prolonged POS.ResultsA total 624 patients were enrolled in the ERALS program. The median POS was 4 days (range 1–63), with 2.9% of ICU postoperative admission. A videothoracoscopic approach was used in 66.6% of cases, and 174 patients (27.9%) experienced at least one POC. Perioperative mortality rate was 0.8% (5 cases). Mobilization to chair in the first 24 h after surgery was achieved in 82.5% of cases, with 46.5% of patients achieving ambulation in the first 24 h. Absence of mobilization to chair and preoperative FEV1% less than 60% predicted, were identified as independent risk factors for POC, while thoracotomy approach and the presence of POC predicted prolonged POS.ConclusionsWe observed a reduction in ICU admissions and POS contemporaneous with the use of an ERALS program in our institution. We demonstrated that early mobilization and videothoracoscopic approach are modifiable independent predictors of reduced POC and POS, respectively. |
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| Keywords: | Enhanced recovery after surgery Perioperative care Postoperative complications Length of stay Morbidity Mortality Rehabilitación multimodal Cuidados postoperatorios Complicaciones postoperatorias Estancia hospitalaria Morbilidad Mortalidad |
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