49 - Freie Mitteilung
Clinical works II
16. Mai 2019, 10:15 - 11:45, Bellavista 2, 6. OG
The impact of patient compliance and individual components in an ERAS pathway on the outcome of anatomical VATS resections
C. Forster, V. Doucet, J.-Y. Perentes, E. Abdelnour-Berchtold, T. Krueger, L. Rosner, M. Gonzalez, Presenter: C. Forster (Lausanne)
Implementation of an enhanced recovery after surgery (ERAS) pathway has shown to improve post-operative outcome. However, the impact of compliance (overall and to specific elements of the program) has been rarely reported in thoracic surgery and was the subject of this study.
We included all consecutive patients undergoing video-assisted thoracoscopy (VATS) anatomical pulmonary resection after the implementation of an ERAS pathway. Demographics, surgical characteristics and peri- and post-operative adherence to 16 elements of the ERAS program were assessed. Post-operative outcomes and length of stay were compared between low (<75% of adherence) and high compliance (>75%) groups. Logistic regression was undertaken to identify individual elements related to post-operative complications and a length of stay of >4 days (delayed discharge).
A total of 192 ERAS patients, 98 women and 94 men, with a median age of 66 years (range 28-87), underwent VATS anatomic lung resection (109 lobectomies, 84 segmentectomies). There was no 30-day mortality and the re-operation rate was 6.3%. The overall compliance to ERAS protocol was 76%. Overall and pulmonary postoperative complications were observed in 33% and 28%, respectively. The median postoperative length of hospitalization was 4 days (range 1-100). The high-compliance group was correlated with fewer complications (OR: 0.25, p<0.0001) and lower rate of delayed discharge (OR: 0.39, p=0.0013). Early removal of chest tubes (OR: 0.26, p<0.002), use of electronical drainage (OR: 0.39, p=0.036), cessation of opioid administration on day 3 (OR: 0.28, p=0.016) and early feeding (OR: 0.12, p=0.014) were all associated with reduced postoperative complications. Shorter hospital stay was correlated with early removal of chest tubes (OR: 0.12, p<0.0001) and cessation of opioid administration on day 3 (OR: 0.23, p=0.001).
High compliance to ERAS program (overall and to some individual elements) seems to improve the post-operative outcome in patients undergoing anatomical pulmonary VATS resections.