VATS Group ERAS Registry

Abstract

Enhanced recovery after surgery (ERAS) is a multimodal, polyhedral approach to surgical management for patients undergoing surgical therapy. Since ERAS is not a specific procedure, these protocols are not exclusively created for particular clinical settings but they are prone to be adapted to a large variety of healthcare programs after surgery. ERAS Society was the platform in which a new multidisciplinary methodology to promote a fast recovery, a considerable patient involvement and resource optimization has been developed. ERAS Society has also produced guidelines for different surgical specialties and has already generated some evidence regarding preoperative, intraoperative and postoperative practice. ERAS in Thoracic Surgery has had a slow-growing development but some hints suggest that introducing ERAS methodology in pulmonary resections for cancer could be feasible and effective with potential tangible benefits for patients, families, caregivers and welfare. There is no evidence yet concerning ERAS principles in Thoracic Surgery; for this reason, a new possibility for prospective data collection and analysis is created using the VATS Group Web Registry in which additional records, documents and facts have now the possibility to be registered and eventually explored to possibly adjust the ERAS protocols to major pulmonary resections.

Keywords: Lung resection; fast recovery; registry; videothoracoscopy.

Figure 1

Admission page. A code is generated by the system and assigned to each patient, a summary of patient perioperative data is furnished and drop-out causes are signaled (arrows).

Figure 2

Preoperative PHE-s is uploaded with a survey model. *, means that the field is required, to be mandatory filled. PHE-s, Patient Health Engagement scale.

Figure 3

Perioperative management page. Information about anemia and nutritional status are presented in this page and information regarding treatment are required. *, means that the field is required, to be mandatory filled.

Figure 4

Physiotherapy page. According to ERAS Society, physiotherapy must be provided during the entire perioperative period; the Registry asks for information regarding preoperative management, number and type of exercises, timing and duration of tutored sessions. *, means that the field is required, to be mandatory filled. ERAS, enhanced recovery after surgery.

Figure 5

Anesthesia page. A list of anesthesiology data is added, with emphasis on cardiovascular and respiratory conditions. *, means that the field is required, to be mandatory filled.

Figure 6

Surgical procedure page. Surgical protocol for ERAS VATS are required, despite information regarding of a possible second chest tube, ERAS protocol is considered accomplished if only one chest tube is placed for a limited duration up to 72 hours (arrows above). Moreover, information of pain relief techniques are required. Finally, intraoperative air leak must be treated with sealants and reported (arrows below). *, means that the field is required, to be mandatory filled. ERAS, enhanced recovery after surgery.

Figure 7

Analgesia data page. The focus of ERAS methodology in the analgesia management is the continuous control of analgesia and the flexibility and patient-centered protocol. ERAS patients must be evaluated at scheduled time, treated with loco-regional techniques with systemic adjuvants. *, means that the field is required, to be mandatory filled. ERAS, enhanced recovery after surgery.

Figure 8

Discharge data page. Patient engagement (PHE-s) is asked again (arrow above); pain condition is remarkable for a fine ERAS process to fast recovery and thus asked again (arrow). The discharge day is hypothetically put at day 4 as the limit for an acceptable ERAS/fast track route. Moreover, information on the chest drainage are requested to highlight the association between discharge from hospital and chest tube management (arrows below). *, means that the field is required, to be mandatory filled. PHE-s, Patient Health Engagement scale; ERAS, enhanced recovery after surgery.

Figure 9

Follow-up data page. A series of data regarding the 30 days after surgery are collected; ERAS items are: patient engagement (arrow above) with a new and final PHE-s, possible causes of readmission to hospital are here placed (arrow) and educational objectives accomplished (arrow below). All complications and events leading to enhanced recovery failure are reported here. *, means that the field is required, to be mandatory filled. PHE-s, Patient Health Engagement scale; ERAS, enhanced recovery after surgery.