Enhanced recovery after surgery (ERAS) versus standard care for children undergoing thoracoscopic anatomical pulmonary resections: A single-center before–after comparative study

Thoracoscopic anatomical pulmonary resection has proven highly effective in adults. However, applying this technique to pediatric patients poses specific challenges due to their unique physiological and psychological traits. The application of the enhanced recovery after surgery (ERAS) concept has proven successful in adults, leading to an investigation into its potential effectiveness in pediatric thoracoscopic anatomical pulmonary resection. We conducted a single-center before-after comparative study at Beijing Children's Hospital including 522 children (ERAS n = 323; standard care n = 199) undergoing thoracoscopic anatomical pulmonary resections from August 2019 to November 2024. The ERAS group underwent perioperative management that adhered to ERAS principles. The outcomes evaluated encompassed operative duration, duration of tube placement, length of hospital stay, hospitalization expenses, and quality of life. Among 522 children (ERAS n = 323; standard care n = 199), ERAS was associated with shorter operative time (53.5 ± 26.4 vs 97.9 ± 50.9 minutes), shorter chest-tube duration (2.0 ± 0.9 vs 4.4 ± 2.5 days), reduced length of stay (7.6 ± 2.8 vs 10.0 ± 4.0 days), and lower hospitalization cost (CNY 31,455.3 ± 6677.9 vs 37,139.8 ± 11,481.7); all P < .001. Quality of life favored ERAS (Barthel Grade 0/1 [≥61 points]: 323/323 [100%] vs 146/199 [73.4%]; Grade 2 seen only in standard care: 53/199 [26.6%]; P < .001). The ERAS management model significantly associated with postoperative recovery, minimizes complications, and decreases hospital stays in pediatric thoracoscopic anatomical pulmonary resection, showcasing substantial clinical benefits. Additional verification in larger groups is necessary to establish its wider applicability.