Objective

ERAS was implemented at GJNH in September 2013 which triggered changes to our clinical practice, in keeping with the ERAS philosophy. Has the introduction of ERAS program helped improve the desired positive outcome after thoracic surgery?

Methods

ERAS goals were set for total stay of less than 7 days for open lung resections and less than 5 for Video Assisted Thoracoscopic (VATS) lung resection. The thoracic surgical care pathways were structured accordingly after identifying areas of potential benefit from ERAS. Pre-operative clinics were encouraged to optimise patients and allow Day of Surgery Admission (DOSA). Encouragement of VATS lung resection and use of paravertebral and intercostal analgesia replaced the previous standard of epid.

Results

The median length of stay for open (n=155) and VATS (n=142) resection groups reduced from 9 to 8 and 7 to 6 days respectively. In the most recent cohort of patients 68% of lung resections were performed via VATS, 78% with Paravertebral analgesia. 66% of patients were discharged from HDU on Post-Operative Day 1. Digital drainage systems were used in 94% of patients facilitating early mobilisation. ERAS targets of patients being discharged home in 7 or 5 days were achieved the highest of 71% and

Conclusion

Adoption of ERAS into current practice has proven to be effective in improving the patient outcome after Thoracic surgery. However, this requires building the infrastructure and training of staff for effective implementation of ERAS.