Budacan Alina-Maria, Mehdi Rana, Kerr Amy Pamela, Kadiri Salma Bibi, Batchelor Timothy J P, Naidu Babu
Department of Thoracic Surgery, Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK.
Department of Thoracic Surgery, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8HW, UK.
J Cardiothorac Surg. 2020 May 14;15(1):95. doi: 10.1186/s13019-020-01121-2.
Evidence that Enhanced Recovery After Thoracic Surgery (ERAS) improves clinical outcomes is growing. Following the recent publications of the international ERAS guidelines in Thoracic surgery, the aim of this audit was to capture variation and perceived difficulties to ERAS implementation, thus helping its development at a national level.
We designed an anonymous online survey and distributed it via email to all 36 centres that perform lung lobectomy surgery in the UK and Ireland. It included 38 closed, open and multiple-choice questions on the core elements of ERAS and took an average of 10 min to complete.
Eighty-two healthcare professionals from 34 out of 36 centres completed the survey; majority were completed by consultant thoracic surgeons (57%). Smoking cessation support varied and only 37% of individuals implemented the recommended period for fluid fasting; 59% screen patients for malnutrition and 60% do not give preoperative carbohydrate loading. The compliance with nerve sparing techniques when a thoracotomy is performed was poor (22%). 66% of respondents apply suction on intercostal drains and although 91% refer all lobectomies for physiotherapeutic assessment, the physiotherapy adjuncts varied across centres. Perceived barriers to implementation were staffing levels, lack of teamwork/consistency, limited resources over weekend and the reduced access to smoking cessation services.
Centres across the UK are working to develop the ERAS pathway. This survey aids this process by providing insight into "real life" ERAS, increasing exposure of staff to the ESTS- ERAS recommendations and identifying barriers to implementation.
胸外科手术后加速康复（ERAS）改善临床结局的证据越来越多。随着国际胸外科ERAS指南的近期发布，本次审核的目的是了解ERAS实施过程中的差异和感知到的困难，从而推动其在国家层面的发展。
我们设计了一项匿名在线调查，并通过电子邮件分发给英国和爱尔兰所有进行肺叶切除术的36个中心。该调查包括38个关于ERAS核心要素的封闭式、开放式和多项选择题，平均需要10分钟完成。
来自36个中心中34个中心的82名医疗保健专业人员完成了调查；大多数由胸外科顾问医生完成（57%）。戒烟支持各不相同，只有37%的人实施了推荐的液体禁食期；59%的人对患者进行营养不良筛查，60%的人不进行术前碳水化合物负荷。开胸手术时神经保留技术的依从性较差（22%）。66%的受访者对肋间引流管进行抽吸，尽管91%的人将所有肺叶切除术转诊进行物理治疗评估，但各中心的物理治疗辅助措施各不相同。实施过程中感知到的障碍包括人员配备水平、缺乏团队合作/一致性、周末资源有限以及戒烟服务获取减少。
英国各地的中心都在努力制定ERAS路径。这项调查通过深入了解“现实生活”中的ERAS、增加工作人员对ESTS-ERAS建议的了解以及识别实施障碍，有助于这一过程。
