Impact of liberalised preoperative water intake and intravenous-to-oral transition on patient experience and system efficiency in thoracic surgery: a before-and-after study

Enhanced Recovery After Surgery (ERAS) protocols aim to improve perioperative care by enhancing patient experience, workflow efficiency, and cost-effectiveness; however, quantitative evidence for their system-level impact in thoracic surgery remains limited. We evaluated patient-reported experience and system efficiency following implementation of an ERAS-based perioperative hydration/medication protocol. We conducted a single-centre comparative before-and-after study and included consecutive patients undergoing pulmonary resection or thymectomy (January–September 2025). The protocol permitted water intake until 3 h before surgery, reduced routine preoperative intravenous hydration, and replaced routine intravenous medications with oral alternatives when appropriate. Primary outcomes were postimplementation patient-reported measures (fasting-related discomfort, satisfaction, and actual preoperative water intake). Secondary outcomes included nursing time for medication-related tasks, perioperative outcomes, and direct institutional costs. We included 461 patients. Protocol implementation was not associated with increased postoperative complications. Within the postimplementation period, reported preoperative water intake was higher after the educational refinement (55.0% vs. 74.7%; relative risk 1.36). Intake was less frequent in men (adjusted odds ratio [aOR], 0.38; P = 0.002) and more frequent among patients scheduled later in operative order (aOR, 1.90; P = 0.044). Discomfort was higher after wedge resection (aOR, 2.13; P = 0.027) and thymectomy (aOR, 2.47; P = 0.011) than after lobectomy, while satisfaction remained high. Transitioning routine medications from IV to oral reduced nursing task time by 71.8% per patient (median, 2.4–8.5 min) and was associated with estimated direct savings of ~ USD 18,700 per 1,000 surgeries. This ERAS-based protocol was associated with high patient-reported satisfaction, improved nursing workflow efficiency, and reduced institutional costs, with no observed safety signal.