F-105ENHANCED RECOVERY AFTER THORACIC SURGERY: OUTCOMES FOLLOWING IMPLEMENTATION OF A TAILORED ERAS PATHWAY IN A TERTIARY CENTRE

Abstract

Aim: Through minimally-invasive video-assisted thoracoscopic surgery(VATS) and evolving pulmonary rehabilitation services, ERAS has been successfully implemented in thoracic surgery, reducing recovery time and complications. We present our tailored ERAS protocol and results for patients undergoing lung resection in a large, tertiary-level centre. Methods: Retrospective case-note analysis of elective, anatomical lung resections during a 3-month period starting July 2014. Key elements of our protocol were evaluated, including preoperative optimisation, surgical approach and analgesia delivery. Results: 56 patients underwent pulmonary resection (9.8%pneumonectomy, 90.2%lobectomy). Median age was 70 years. Lung carcinoma was the foremost indication (92.1%), predominantly T2(51.0%) N0(58.8%) staging. Smoking cessation services were utilised in 28.6% of eligible cases; carbohydrate loading in 30.6%. Preoperative sedation fell to 3.9%. Day case admissions were 70.6%. 64.7% of procedures were VATS (conversion rate 15.7%). Paravertebral and intercostal blocks were used in 88.2% and patient-controlled analgesia in 96.1%. Most frequent complications were cardiovascular (AF/PE/DVT) (8%). Unexpected ICU admissions occurred in 3.9%, with 1 mortality (2.0%). Median length-of-stay (LOS) was 5 days with readmission rate (<30days) 11.6%. Conclusion: ERAS can successfully be applied to thoracic surgery patients. In our centre, LOS reduced by 2 days for major resections, with fastest recovery following minimally-invasive surgery. This could be reduced further by optimising preoperative fitness.