Anatomic Lung Resection Outcomes After Implementation of a Universal Thoracic ERAS Protocol Across a Diverse Healthcare System

Abstract

Objective: We sought to evaluate how implementing a thoracic Enhanced Recovery After Surgery (ERAS) protocol impacted surgical outcomes after elective anatomic lung resection. Summary Background Data: The effect of implementing the ERAS Society/European Society of Thoracic Surgery (ESTS) thoracic ERAS protocol on postoperative outcomes throughout an entire healthcare system has not yet been reported. Methods: This was a prospective cohort study within one healthcare system (1/2019-3/2023). A thoracic ERAS protocol was implemented on 5/1/2021 for elective anatomic lung resections, and postoperative outcomes were tracked using the electronic health record and Vizient data. The primary outcome was overall morbidity; secondary outcomes included individual complications, length of stay (LOS), opioid use, chest tube duration, and total cost. Patients were grouped into pre- and post-ERAS cohorts. Bivariable comparisons were performed using independent t-test, chi-square, or Fisher’s exact tests, and multivariable logistic regression was performed to control for confounders. Results: There were 1,007 patients in the cohort; 450 (44.7%) were in the post-ERAS group. Mean age was 66.2 years; most patients were female (65.1%), white (83.8%), had a BMI between 18.5-29.9 (69.7%), and were ASA class 3 (80.6%). Patients in the post-implementation group had lower risk-adjusted rates of any morbidity, any respiratory complication, pneumonia, surgical site infection, arrhythmias, infections, opioid usage, ICU use, and shorter postoperative LOS (all P<0.05). Conclusions: Postoperative outcomes were improved after implementation of an evidence-based thoracic ERAS protocol throughout the healthcare system. This study validates the ERAS Society/ESTS guidelines and demonstrates that simultaneous multihospital implementation can be feasible and effective.