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Eur J Cardiothorac Surg. 2018 Oct 9. doi: 10.1093/ejcts/ezy301. [Epub ahead of print]

Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS).

Author information

1
Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
2
Department of Anaesthesia, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
3
Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
4
Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK.
5
Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, USA.
6
Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
7
Department of Thoracic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
8
Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, USA.
9
Department of Anesthesia, University Health Network - Toronto General Hospital, Toronto, ON, Canada.
10
Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Birmingham, UK.

Abstract

Enhanced recovery after surgery is well established in specialties such as colorectal surgery. It is achieved through the introduction of multiple evidence-based perioperative measures that aim to diminish postoperative organ dysfunction while facilitating recovery. This review aims to present consensus recommendations for the optimal perioperative management of patients undergoing thoracic surgery (principally lung resection). A systematic review of meta-analyses, randomized controlled trials, large non-randomized studies and reviews was conducted for each protocol element. Smaller prospective and retrospective cohort studies were considered only when higher-level evidence was unavailable. The quality of the evidence base was graded by the authors and used to form consensus recommendations for each topic. Development of these recommendations was endorsed by the Enhanced Recovery after Surgery Society and the European Society for Thoracic Surgery. Recommendations were developed for a total of 45 enhanced recovery items covering topics related to preadmission, admission, intraoperative care and postoperative care. Most are based on good-quality studies. In some instances, good-quality data were not available, and subsequent recommendations are generic or based on data extrapolated from other specialties. In other cases, no recommendation can currently be made because either equipoise exists or there is a lack of available evidence. Recommendations are based not only on the quality of the evidence but also on the balance between desirable and undesirable effects. Key recommendations include preoperative counselling, nutritional screening, smoking cessation, prehabilitation for high-risk patients, avoidance of fasting, carbohydrate loading, avoidance of preoperative sedatives, venous thromboembolism prophylaxis, prevention of hypothermia, short-acting anaesthetics to facilitate early emergence, regional anaesthesia, nausea and vomiting control, opioid-sparing analgesia, euvolemic fluid management, minimally invasive surgery, early chest drain removal, avoidance of urinary catheters and early mobilization after surgery. These guidelines outline recommendations for the perioperative management of patients undergoing lung surgery based on the best available evidence. As the recommendation grade for most of the elements is strong, the use of a systematic perioperative care pathway has the potential to improve outcomes after surgery.

PMID:
30304509
DOI:
10.1093/ejcts/ezy301

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