Postoperative care after thoracic surgery in the times of ERAS

Abstract

This review documents the importance of postoperative interventions that accelerate the functional recovery of the thoracic surgical patient. Enhanced recovery after surgery (ERAS) pathways aim to mitigate the harmful surgical stress response. Improvements to the entire patient pathway, by removing unnecessary care elements while introducing evidence-based interventions, have synergistic effects. At the same time, some key care elements appear to be more important than others, including early removal of chest tubes, early mobilization, and the limited use of opioids. These care elements are all intertwined. The goals of early mobilization and opioid-sparing analgesia are more readily achieved once a chest tube has been removed. A focus on achieving these goals earlier, including on the day of surgery, may benefit a patient's recovery further. The result is superior patient outcomes including a quicker restoration of normal function, fewer complications, reduced opioid requirements, reduced costs, and a shorter length of stay.

Keywords: Chest tube management; Early mobilization; Enhanced recovery after surgery; Opioid-sparing analgesia.