Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

A surgical perspective of ERAS guidelines in thoracic surgery

Batchelor, Tim J.P.a; Ljungqvist, Olleb

Current Opinion in Anesthesiology: February 2019 - Volume 32 - Issue 1 - p 17–22
doi: 10.1097/ACO.0000000000000685
THORACIC ANESTHESIA: Edited by Albert C. Perrino Jr

Purpose of review Guidelines for enhanced recovery after surgery (ERAS) have recently been published for lung surgery. Although some of the recommendations are generic or focused on anesthetic and nursing care, other recommendations are more specific to a thoracic surgeon's practice. The present review concentrates on the surgical approach, optimal chest drain management, and the importance of early mobilization.

Recent findings Most lung cancer resections are still performed via an open thoracotomy approach. If a thoracotomy is to be used, a muscle-sparing approach may result in reduced pain and better postoperative function. Sparing of the intercostal bundle also reduces pain. There is now evidence that minimally invasive surgery for early lung cancer results in superior patient outcomes. Postoperatively, single chest tubes should be used without the routine application of external suction. Digital drainage systems are more reliable and may produce superior outcomes. Conservative chest drain removal policies are unnecessary and impair patient recovery. Early mobilization protocols should be instigated to reduce postoperative complications.

Summary The use of ERAS after lung surgery has the potential to improve patient outcomes. Although specific surgical elements are in the minority, thoracic surgeons should be involved in all aspects of perioperative care as part of the wider multidisciplinary team.

aDepartment of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK

bDepartment of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden

Correspondence to Tim J.P. Batchelor, MBChB, BSc, MSc, FRCS, Department of Thoracic Surgery, Bristol Royal Infirmary, Upper Maudlin Street, Bristol BS2 8HW, UK. Tel: +44-117-3423132; e-mail:

Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.