Influence of enhanced recovery after surgery (ERAS) on patients receiving lung resection: a retrospective study of 1749 cases.

BACKGROUND: The study aimed to evaluate the outcomes following the implementation of enhanced recovery after surgery (ERAS) for patients undergoing lung cancer surgery. METHOD: A retrospective cohort study involving 1749 patients with lung cancer undergoing pulmonary resection was conducted. The patients were divided into two time period groups for analysis (routine pathway and ERAS pathway). Logistic regression analysis was performed to assess the risks of developing postoperative pulmonary complications. RESULTS: Among the 1749 patients, 691 were stratified into the ERAS group, and 1058 in to the routine group. The ERAS group presented with shorter postoperative in-hospital length of stay (LOS) (4.0 vs 6.0, P < 0.001), total LOS (10.0 vs. 13.0 days, P < 0.001), and lower total in-hospital costs (P < 0.001), including material (P < 0.001) and drug expenses (P < 0.001). Furthermore, the ERAS group also presented with a lower occurrence of postoperative pulmonary complications (PPCs) than the routine group (15.2% vs. 19.5%, P = 0.022). Likewise, a significantly lower occurrence of pneumonia (8.4% vs. 14.2%, P < 0.001) and atelectasis (5.9% vs. 9.8%, P = 0.004) was found in the ERAS group. Regarding the binary logistic regression, the ERAS intervention was the sole independent factor for the occurrence of PPCs (OR: 0.601, 95% CI 0.434-0.824, P = 0.002). In addition, age (OR: 1.032, 95% CI 1.018-1.046), COPD (OR: 1.792, 95% CI 1.196-2.686), and FEV1 (OR: 0.205, 95% CI 0.125-0.339) were also independent predictors of PPCs. CONCLUSION: Implementation of an ERAS pathway shows improved postoperative outcomes, including shortened LOS, lower in-hospital costs, and reduced occurrence of PPCs, providing benefits to the postoperative recovery of patients with lung cancer undergoing surgical treatment.

The Feasibility and Safety of No Placement of Urinary Catheter Following Lung Cancer Surgery: A Retrospective Cohort Study With 2,495 Cases.

OBJECTIVES: The study was aimed to investigate the safety and feasibility of avoiding urinary catheterization after surgery in patients undergoing lung cancer resection. METHODS: Between 1 January 2014 and 31 December 2017, the patients with primary lung cancer who received lobectomy or segmental resection via video-assisted thoracic surgery (VATS) in our department were screened. Based on whether a urinary catheter was inserted after surgery, patients were divided into urinary catheter (UC) group or non-UC group, and rates of postoperative urinary retention (POUR), urinary catheter re-insertion and urinary tract infection (UTI) were compared. RESULTS: There was no difference in International prostate symptom score (p = .268) between the groups, but a higher Sedation-Agitation Scale (SAS) score was found in UC group [4.0 (3.0 4.0) vs. 4.0 (2.0, 4.0); p < .001], with a higher proportion of patients with agitation (SAS score > 4; 17.3%, 317/1,835 vs. 12.9%, 86/660, p = .008). In contrast, a higher rate of POUR was observed in non-UC group (11.2%, 74/660 vs. 7.4%, 136/1,835, p = .003), whereas the rate of UTI was significantly lower in this group (5.8%, 38/660 vs. 8.3%, 153/1,835, p = .033). Multivariable analysis revealed the non-placement of UC as the independent factor for POUR (OR: 1.542, 95%CI: 1.135-2.095, p = .006) and UTI (OR: 0.664, 95%CI: 0.459-0.962, p = .031). CONCLUSION: This retrospective study with large sample of 2,495 patients provided evidence to the hypothesis that avoiding urinary catheterization contributed to decrease in the incidence of UTI and was safe and feasible in patients undergoing lung cancer surgery.

Impact of one-week preoperative physical training on clinical outcomes of surgical lung cancer patients with limited lung function: a randomized trial.

BACKGROUND: To investigate the influence of preoperative physical training combining aerobic and breathing exercises on surgical lung cancer patients with impaired lung function. METHODS: A total of 68 patients with predicted postoperative FEV1% <60% were equally and randomly assigned into one-week physical training combining aerobic and breathing exercises (intervened group: IG) or routine preoperative preparation (control group: CG). Then, 6-min walking distance (6-MWD), in-hospital length of stay (LOS), and other clinical variables were included and recorded. RESULTS: An increase of 22.6±27.0 m of 6-MWD was observed in IG, compared to 2.7±27.6 m in CG (between-group difference: 19.9 m, 95% CI: 6.7 to 33.2, P=0.004), but no difference was found in lung function. The emotional function of EORTC-QLQ-30 was significantly improved in IG after the training regimen, compared to CG. Meanwhile, the intervened patients (IG) had significantly lower postoperative pulmonary complication (PPC) rate (11.8%, 4/34 vs. 35.3%, 12/34, P=0.022), shorter postoperative LOS [median: 5.0 interquartile (4.0-7.0) vs. 8.0 (7.0-10.0) days, P<0.001] and lower costs, including total cost [48,588.7 (44,999.1-52,693.3) vs. 52,445.3 (49,002.9-61,994.0) ¥, P=0.016], material cost [23,350.8 (18,300.6-26,421.9) vs. 25,730.0 (21,328.7-29,250.2) ¥, P=0.048] and drug cost [7,230.0 (6,661.9-8,347.4) vs. 11,388.6 (7,963.0-16,314.3) ¥, P<0.001]. CONCLUSIONS: The preoperative physical training combining aerobic and breathing exercises can improve exercise capacity, decrease the occurrence of PPCs, and shorten LOS with lower in-hospital cost; it thus shows potential to be an effective preparation strategy for surgical lung cancer patients with limited lung function.