Implementation of enhanced recovery after surgery program for lung resection

Abstract: Enhanced recovery after surgery (ERAS) is an evidence-based multimodal protocol of perioperative care. ERAS pathways aim to encompass multiple aspects of the patient trajectory, from referral to recovery. In recent years many ERAS protocols in lung surgery have been established and investigated. The multitude of possible interventions and variability among centers and surgeons make it hard to investigate the impact of each intervention, or pathway. Even with those limitations, ERAS pathways in lung surgery demonstrated benefits such as shorter length of stay (LOS), lower hospital costs, and fewer pulmonary and cardiac complications. In this clinical practice review, we focus on key elements of patient care that are particularly important in lung surgery, including preoperative assessment and counseling, pulmonary functions, preoperative exercise and prehabilitation, pain management, surgical technique, chest drain management, and the use of incentive spirometry. Additionally, we share our experience at the McGill University Health Centre (MUHC) in the development and successful implementation of ERAS protocols in lung surgery, along with our ongoing efforts to reduce complications and LOS, while enhancing the overall patient experience. In conclusion, we assert that the adoption of ERAS protocols in lung surgery is a multidisciplinary process that is both feasible and safe, contributing to improved patient outcomes.