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A surgical perspective of ERAS guidelines in thoracic surgery
Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Örebro University, School of Medical Sciences. Department of Surgery.ORCID iD: 0000-0003-2636-4745
2019 (English)In: Current Opinion in Anaesthesiology, ISSN 0952-7907, E-ISSN 1473-6500, Vol. 32, no 1, p. 17-22Article in journal (Refereed) Published
Abstract [en]

PURPOSE OF REVIEW: Guidelines for enhanced recovery after surgery (ERAS) have recently been published for lung surgery. Although some of the recommendations are generic or focused on anesthetic and nursing care, other recommendations are more specific to a thoracic surgeon's practice. The present review concentrates on the surgical approach, optimal chest drain management, and the importance of early mobilization.

RECENT FINDINGS: Most lung cancer resections are still performed via an open thoracotomy approach. If a thoracotomy is to be used, a muscle-sparing approach may result in reduced pain and better postoperative function. Sparing of the intercostal bundle also reduces pain. There is now evidence that minimally invasive surgery for early lung cancer results in superior patient outcomes. Postoperatively, single chest tubes should be used without the routine application of external suction. Digital drainage systems are more reliable and may produce superior outcomes. Conservative chest drain removal policies are unnecessary and impair patient recovery. Early mobilization protocols should be instigated to reduce postoperative complications.

SUMMARY: The use of ERAS after lung surgery has the potential to improve patient outcomes. Although specific surgical elements are in the minority, thoracic surgeons should be involved in all aspects of perioperative care as part of the wider multidisciplinary team.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2019. Vol. 32, no 1, p. 17-22
Keywords [en]
enhanced recovery after surgery, lung surgery, perioperative care, thoracic surgery
National Category
Surgery Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:oru:diva-72046DOI: 10.1097/ACO.0000000000000685ISI: 000467342600004PubMedID: 30589662Scopus ID: 2-s2.0-85059237383OAI: oai:DiVA.org:oru-72046DiVA, id: diva2:1288001
Available from: 2019-02-12 Created: 2019-02-12 Last updated: 2019-06-19Bibliographically approved

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Ljungqvist, Olle

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CiteExportLink to record
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