The impact of enhanced recovery after surgery (ERAS) protocol compliance on morbidity from resection for primary lung cancer
| Autor: | Lesley Wood, Neil J. Rasburn, Timothy J.P. Batchelor, Natasha Joshi, Luke J Rogers, David E. Messenger, David Bleetman |
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| Rok vydání: | 2018 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty business.industry medicine.medical_treatment Confounding Odds ratio 030204 cardiovascular system & hematology medicine.disease Confidence interval Surgery 03 medical and health sciences 0302 clinical medicine 030228 respiratory system Cardiothoracic surgery Video-assisted thoracoscopic surgery medicine medicine.symptom Cardiology and Cardiovascular Medicine business Prospective cohort study Lung cancer Postoperative nausea and vomiting |
| Zdroj: | The Journal of Thoracic and Cardiovascular Surgery. 155:1843-1852 |
| ISSN: | 0022-5223 |
| Popis: | Objective The adoption of Enhanced Recovery After Surgery programs in thoracic surgery is relatively recent with limited outcome data. This study aimed to determine the impact of an Enhanced Recovery After Surgery pathway on morbidity and length of stay in patients undergoing lung resection for primary lung cancer. Methods This prospective cohort study collected data on consecutive patients undergoing lung resection for primary lung cancer between April 2012 and June 2014 at a regional referral center in the United Kingdom. All patients followed a standardized, 15-element Enhanced Recovery After Surgery protocol. Key data fields included protocol compliance with individual elements, pathophysiology, and operative factors. Thirty-day morbidity was taken as the primary outcome measure and classified a priori according to the Clavien-Dindo system. Logistic regression models were devised to identify independent risk factors for morbidity and length of stay. Results A total of 422 consecutive patients underwent lung resection over a 2-year period, of whom 302 (71.6%) underwent video-assisted thoracoscopic surgery. Lobectomy was performed in 297 patients (70.4%). Complications were experienced by 159 patients (37.6%). The median length of stay was 5 days (range, 1-67), and 6 patients (1.4%) died within 30 days of surgery. There was a significant inverse relationship between protocol compliance and morbidity after adjustment for confounding factors (odds ratio, 0.72; 95% confidence interval, 0.57-0.91; P 5 days). Conclusions Increased compliance with an Enhanced Recovery After Surgery pathway is associated with improved clinical outcomes after resection for primary lung cancer. Several elements, including early mobilization, appear to be more influential than others. |
| Databáze: | OpenAIRE |
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