Esophagectomy Enhanced Recovery After Surgery Initiative Results in Improved Outcomes

Development of a Venous Thromboembolism Prophylaxis and Pain Medication Pathway in Thoracic Surgery Enhanced Recovery After Surgery Program

INTRODUCTION

This study aimed to evaluate the beneficial role of clinical pharmacists through a quality improvement project to incorporate a medication pathway into a thoracic surgery Enhanced Recovery After Surgery (ERAS) program.

METHODS

The retrospective cohort study developed a venous thromboembolism (VTE) prophylaxis and pain medication pathway covering the different phases of the perioperative period in the thoracic surgery ERAS program, adhering to Lean management principles, within a multidisciplinary team framework. Outcome indicators related to VTE prophylaxis and pain management, adverse events, per capita drug cost, length of stay, and the total inpatient cost between the first 6 mos (preintervention, January 2023 to June 2023) and the second 6 mos (postintervention, July 2023 to December 2023) were collected and compared.

RESULTS

A total of 1463 individuals were observed. Following the intervention, VTE risk assessment exceeded 95%, and the number of VTE cases notably decreased from 2 to 0. Pain relief was significantly enhanced (χ2 = 4.423, P = 0.035) and the incidence of nausea and vomiting was significantly lower (χ2 = 4.869, P = 0.027) when surgeons stopped using opioid agonist-antagonists. The per capita drug cost reduced from $639.04 to $479.39, the length of stay decreased from 13.68 ds to 12.23 ds, and the per capita total inpatient cost decreased from $6705.62 to $5460.81.

CONCLUSIONS

A medication pathway was significantly associated with improved outcome metrics related to VTE prophylaxis and pain management in thoracic surgery and can be incorporated into ERAS management programs. Further investigations using more current data are needed.

The application of ERAS in the perioperative period management of patients for lung transplantation

Objective

To explore the application of enhanced recovery after surgery (ERAS) in the perioperative period of lung transplantation.

Methods

We retrospectively collected the clinical data of 27 lung transplant patients who underwent ERAS during the perioperative period, while 12 lung transplant patients receiving routine treatment served as controls. General information was collected, including the specific implementation plan of ERAS, the incidence of complications and survival rate during the perioperative period (<30 d), postoperative hospitalization indicators, the postoperative length of stay, and numerical rating scale (NRS) scores.

Results

Comparison of postoperative hospitalization indicators, the ERAS group compared with the control group, there were significant differences in postoperative ICU stay time (2.0(2.0,4.0) vs 4.5(3.0,6.0), p = 0.005), postoperative hospital stay time (18(15,26) vs 24(19.5,32.75), p = 0.016), duration of nasogastric tube (3(2,3) vs 4(2.25,4.75), p = 0.023), and first ambulation time (4(3,5) vs 5.8(4.5,7.5), p = 0.004). There was no significant difference in postoperative invasive mechanical ventilation time, time to eat after surgery, duration of urinary catheter and duration of chest tube between the ERAS group and the control group (p>0.05). The perioperative survival of the ERAS group was 81.5%, which was higher than the control group (66.7%), but there is no statistically significant difference. Comparison of post-extubation NRS scores, the ERAS group had lower NRS scores at 12 h (5.30 ± 0.14 vs 6.25 ± 0.75), 24 h (3.44 ± 0.64 vs 5.58 ± 0.9), 48 h (2.74 ± 0.66 vs 4.08 ± 0.79) and 72 h (1.11 ± 0.80 vs 2.33 ± 0.49) than the control group, the difference was statistically significant (p<0.01). Intra-group comparison, post-extubation 12 h comparison post-extubation 24 h, 48 h, 72 h, the NRS scores showed a gradual downward trend, the difference was statistically significant (p<0.01). In the comparison of perioperative complications, the ERAS group had a lower postoperative infection incidence than the control group, the difference was statistically significant (44.4% vs 83.3%, p = 0.037). The ERAS group had lower postoperative delirium incidence than the control group, the difference was statistically significant (11.1% vs 50%, p = 0.014). There was no significant difference in the incidence of acute rejection, primary graft loss (PGD), gastrointestinal (GI) complications and airway complications between two groups (p>0.05).

Conclusion

The ERAS can be applied to lung transplant patients to relieve postoperative pain, shorten postoperative tube time, and shorten postoperative stay. Perioperative pulmonary rehabilitation exercises are beneficial to reducing the occurrence of postoperative pulmonary complications.