Can postoperative complications be reduced by the application of ERAS protocols in operated non-small cell lung cancer patients?

Prediction of postoperative intensive care unit admission with artificial intelligence models in non-small cell lung carcinoma

BACKGROUND

There is no standard practice for intensive care admission after non-small cell lung cancer surgery. In this study, we aimed to determine the need for intensive care admission after non-small cell lung cancer surgery with deep learning models.

METHODS

The data of 953 patients who were operated for non-small cell lung cancer between January 2001 and 2023 was analyzed. Clinical, laboratory, respiratory, tumor's radiological and surgical features were included as input data in the study. The outcome data was intensive care unit admission. Deep learning was performed with the Fully Connected Neural Network algorithm and k-fold cross validation method.

RESULTS

The training accuracy value was 92.0%, the training F1 1 score of the algorithm was 86.7%, the training F1 0 value was 94.2%, and the training F1 average score was 90.5%. The test sensitivity value of the algorithm was 67.7%, the test positive predictive value was 84.0%, and the test accuracy value was 85.3%. Test F1 1 score was 75.0%, test F1 0 score was 89.5%, and test F1 average score was 82.3%. The AUC in the ROC curve created for the success analysis of the algorithm's test data was 0.83.

CONCLUSIONS

Using our method deep learning models predicted the need for intensive care unit admission with high success and confidence values. The use of artificial intelligence algorithms for the necessity of intensive care hospitalization will ensure that postoperative processes are carried out safely using objective decision mechanisms.

Minimally invasive surgery, precise anesthesia and effective analgesia are crucial for walking within 1 hour after lung surgery

Background

The clinical effectiveness of enhanced recovery after surgery (ERAS) strategy, which emphasizes a comprehensive intervention without highlighting key points, seems to have reached a bottleneck. This study focuses on surgery, anesthesia and postoperative analgesia as the three key factors, to observe the related manifestations of ERAS in patients undergoing lung surgery with minimal intervention throughout the perioperative period.

Methods

All patients who underwent lung surgery by micro-invasive video-assisted thoracoscopic surgery (VATS) at Taizhou Municipal Hospital from August 2018 to August 2019 were consecutively enrolled in the study. The clinical data of patients were collected to observe the results of ERAS. The patients were divided into intravenous analgesia group and intercostal nerve block group according to different analgesic methods, and the ERAS results of the two analgesic methods were compared.

Results

A total of 242 patients were included in the study. The time from cessation of anesthesia to extubation was 10 [interquartile range (IQR), 9, 12] minutes (min), the time from extubation to limb activity according to instructions was 18 (IQR, 14, 23) min, time to sit up was 18 (IQR, 14, 23) min, time to stand up was 40 (IQR, 35, 46) min, and time to walk was 48 (IQR, 45, 55) min. No patient had any anesthesia complications. Compared with the intravenous analgesia group, the intercostal nerve block group had shorter time to limb activity according to instructions, time to sit up and time to walk after extubation, and lower postoperative pain scores (P<0.05).

Conclusions

For patients undergoing thoracic surgery, focusing on surgery, anesthesia and analgesia the three key factors, using micro-invasive VATS to reduce surgical trauma and shorten operation time, precise individualized anesthesia program and effective postoperative analgesia can achieve early autonomous activity of patients after surgery.

Does Enhanced Recovery After Surgery Protocols Reduce Complications and Length of Stay After Thoracic Surgery: A Systematic Review of the Literature

Enhanced recovery after surgery (ERAS) has an increasingly important role in the perioperative management of thoracic surgical patients. It has been extensively studied in multiple surgical specialties, particularly colorectal surgery, where ERAS protocols have been shown to reduce postoperative length of stay and postoperative complications. Electronic searches of two research databases were performed: PubMed (1972 to October 2023) and Ovid MEDLINE (1946 to October 2023). The literature search was completed on January 4, 2024. Search terms included: "thoracic surgery" and "ERAS" or "Enhanced Recovery After Surgery". The search was limited to studies evaluating humans undergoing thoracic surgery for any indication. The primary outcome was overall morbidity, with secondary outcomes including mortality, length of stay, and pulmonary complications. The search yielded a total of 794 records, of which 30 (four meta-analyses and 26 observational trials) met the relevant inclusion and exclusion criteria. This review suggested the implementation of ERAS protocols can lead to a reduction in postoperative morbidity; however, this was not a consistent finding. The majority of studies included demonstrated a reduction in the length of stay with the implementation of ERAS. Overall, ERAS/ERATS is an important adjunct to the management of patients requiring thoracic surgery, consistently leading to shorter lengths of stay and likely contributing to reduced rates of postoperative morbidity. Further research will be required to determine the impact of the recently released ERATS guidelines.

Factors influencing the length of stay (LOS) undergoing robot-assisted thoracoscopic lung surgery in the setting of enhanced recovery after surgery (ERAS) protocol for pediatric patients: a retrospective study

Background

A prolonged length of stay (LOS) after surgery may result in higher hospital costs and hospital-acquired complications. This study aims to identify the risk factors associated with a prolonged hospital stay after robot-assisted thoracoscopic lung surgery for pediatric patients in the context of enhanced recovery after surgery.

Methods

The data for this retrospective study were collected from pediatric patients undergoing robot-assisted thoracoscopic lung surgery. Patients were divided into two subgroups based on median postoperative LOS (Group I: LOS > median 5 days and Group II: LOS ≤ median 5 days). Logistic regression analysis was used to identify the potential factors associated with increased LOS.

Results

This study included 241 patients, 71 (29.46%) with an LOS of >5 days. The proportion of older children was significantly higher in Group I than that in Group II (P=0.004). Patients in Group I were more likely to experience a longer duration of anesthesia and surgery (P<0.001). They also had significantly higher rates of pneumonia, pleural effusion, and liver function damage (P<0.05). Several factors were identified to be associated with an increased LOS after robot-assisted thoracoscopic lung surgery: age >6 years [odds ratio (OR) =3.214, 95% confidence interval (CI): 1.464-7.502, P=0.004], surgery duration >100 min (OR =2.138, 95% CI: 1.296-4.387, P=0.005), intra-albumin (OR =13.778, 95% CI: 1.470-129.116, P=0.022), and blood loss >5 mL (OR =2.184, 95% CI: 1.082-4.409, P=0.029).

Conclusions

The results revealed that older age, longer surgery duration, use of intra-albumin, and more blood loss predict longer postoperative hospital stay in pediatric patients with congenital lung lesions after robot-assisted thoracoscopic lung surgery.