The latest guidelines for the perioperative management of the thoracic noncardiac patient: a critical appraisal of the literature

PURPOSE OF REVIEW: The management of patients before, during, and after surgical procedures on the thorax is influenced by a rapidly expanding set of guidelines that are only partially overlapping. The review is intended for clinicians who are interested in understanding how publication date influences their recommendations, and the points of agreement and divergence between sources. RECENT FINDINGS: Across the preoperative, intraoperative, and postoperative phases, the reviewed documents converge strongly on core process measures. These measures encompass multimodal opioid-sparing analgesia, a single chest drain, early ambulation, and the avoidance of reflex ICU admission. However, there is less consistency in the numerical thresholds, including exercise-testing cut-offs, transfusion triggers, and drain-removal volumes. The most recent documents demonstrate a shift toward more permissive values and an increasing emphasis on frailty, sarcopenia, and patient-reported outcomes. SUMMARY: The core enhanced recovery after surgery process measures have been demonstrated to be reliable. However, it is imperative for clinicians to ascertain the underlying guideline generation for any numerical threshold before its implementation. A significant number of intraoperative decisions are still made based on expert opinion rather than guideline-grade evidence, underscoring the necessity for future trials and consensus on patient-centered outcome measurement.