Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Editorial
. 2021 Jul 15:7:370-391.
doi: 10.1016/j.xjon.2021.07.007. eCollection 2021 Sep.

Enhanced recovery after thoracic surgery: Systematic review and meta-analysis

Audrey L Khoury  1   2   3 , Katharine L McGinigle  3 , Nikki L Freeman  2 , Helal El-Zaatari  2 , Cynthia Feltner  4   5 , Jason M Long  3 ; University of North Carolina School of Medicine Enhanced Recovery Program Working Group
Collaborators, Affiliations
Editorial

Enhanced recovery after thoracic surgery: Systematic review and meta-analysis

Audrey L Khoury et al. JTCVS Open. .

Abstract

ERATS decreased length of stay, postoperative complications, and readmission.

Keywords: ERATS, enhanced recovery after thoracic surgery; LOS, length of stay; RCT, randomized controlled trial; SR, systematic review; VATS, video-assisted thoracoscopic surgery; enhanced recovery after surgery; lung resection; meta-analysis; systematic review.

PubMed Disclaimer

Figures

None
Graphical abstract
None
ERATS decreased length of stay, postoperative complications, and readmission.
Figure 1
Figure 1
L'abbe plot for 30-day readmission. For each study, the 30-day readmission rate for the nonenhanced recovery after thoracic surgery (non-ERATS) group (horizontal axis) was plotted against the 30-day readmission rate for the ERATS group (vertical axis). The studies are plotted as points of varying sizes. The larger points indicate greater precision (1/standard error) in the treatment effect estimate between the 2 groups in the study, smaller points indicate less precision. In the meta-analysis, more precise estimates are given more weight. The gray 45° line indicates equal event rates between the 2 groups. The red line indicates the random-effects meta-analysis event rate. Points above the gray line indicate a higher observed event rate in the ERATS group compared with the non-ERATS group, points below the gray line indicate a higher observed event rate in the non-ERATS group, and points along the gray line indicate equal observed event rates between the ERATS and non-ERATS group. Similarly, points above the red line indicate higher observed event rates in the ERATS group than the estimated meta-analytic effect, points below the red line indicate higher observed event rates in the non-ERATS group than the estimated meta-analytic effect, and point on the red line indicate observed event rates exactly that of the estimated meta-analytic effect.
Figure 2
Figure 2
Forest plot for length of stay. For each study, a point along the horizontal axis denotes the mean difference between the enhanced recovery after thoracic surgery (ERATS) group and the non-ERATS group. The size of the point is proportional to the precision of the estimate with more precise estimates, estimates with smaller standard errors, having larger points and less precise estimates represented with smaller points. The 95% confidence intervals for the mean difference are also plotted. Points to the left of the gray vertical line at x = 0 indicate that the ERATS group had shorter mean lengths of stays than that of the non-ERATS group; points to the left of the gray vertical line indicate that the ERATS group had longer mean lengths of stays than the non-ERATS group; and points on the gray line indicate no difference in the mean lengths of stays between the 2 groups. The dotted red line indicates the grand mean from the random-effects meta-analysis.
Figure 3
Figure 3
In this systematic review and meta-analysis of enhanced recovery after thoracic surgery (ERATS), we analyzed 19 studies comparing pre-ERATS and post-ERATS outcomes (N = 8447 patients overall) per the preferred reporting items for systematic reviews and meta-analyses guidelines. ERATS decreased length of stay, postoperative complications, and readmission. Randomized controlled trials and studies regarding cost and patient-reported outcomes (pain and patient satisfaction) are warranted.
Figure E1
Figure E1
Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow diagram of disposition of articles.
Figure E2
Figure E2
Study attrition for meta-analysis. LOS, Length of stay; IQR, interquartile range.
See this image and copyright information in PMC

References

    1. Melnyk M., Casey R.G., Black P., Koupparis A.J. Enhanced recovery after surgery (ERAS) protocols: time to change practice? Can Urol Assoc J. 2011;5:342–348. - PMC - PubMed
    1. Gimenez-Mila M., Klein A.A., Martinez G. Design and implementation of an enhanced recovery program in thoracic surgery. J Thorac Dis. 2016;8:S37–S45. - PMC - PubMed
    1. Batchelor T.J.P., Rasburn N.J., Abdelnour-Berchtold E., Brunelli A., Cerfolio R.J., Gonzalez M., et al. Guidelines for enhanced recovery after lung surgery: recommendations of the enhanced recovery after surgery (ERAS) Society and the European Society of Thoracic Surgeons (ESTS) Eur J Cardiothorac Surg. 2019;55:91–115. - PubMed
    1. Rogers L.J., Bleetman D., Messenger D.E., Joshi N.A., Wood L., Rasburn N.J., et al. The impact of enhanced recovery after surgery (ERAS) protocol compliance on morbidity from resection for primary lung cancer. J Thorac Cardiovasc Surg. 2018;155:1843–1852. - PubMed
    1. Bryant A.S., Cerfolio R.J. The analysis of a prospective surgical database improves postoperative fast-tracking algorithms after pulmonary resection. J Thorac Cardiovasc Surg. 2009;137:1173–1179. - PubMed

Publication types