Stiles Erik, Harika Ricky, Kuppusamy Madhan, Sternbach Joel, Low Donald E, Hubka Michal
Department of Thoracic Surgery, Virginia Mason Medical Center, Seattle, WA, USA.
Department of Anesthesia, Virginia Mason Medical Center, Seattle, WA, USA.
World J Surg. 2025 Feb;49(2):316-326. doi: 10.1002/wjs.12453. Epub 2025 Jan 3.
Application of enhanced recovery after surgery (ERAS) pathways in robotic lobectomy have been associated with decreased length of stay (LOS). We evaluated differences in patient characteristics and achievements of ERAS benchmarks by discharge groups at a tertiary referral center.
We performed a retrospective analysis of a prospectively maintained ERAS database of patients undergoing robotic lobectomy for pulmonary malignancy. Patients were trifurcated into LOS groups, postoperative day 1, 2-3, and 4+. Preoperative and perioperative variables, ERAS achievement, complications, and readmissions were analyzed.
Between October 2018 and August 2022, 145 consecutive patients were reviewed. Eighty-two (56.6%) were discharged on POD 1, 50 (34.5%) on POD 2-3, and 13 (9.0%) on POD 4+. Patients achieving POD 1 discharge were associated with better preoperative pulmonary function (FEV p = 0.023 and DLCO p = 0.007) and shorter operative times (p < 0.001). Most air leaks (n = 30, 54.5%) were resolved by discharge; however, 25 (17.2%) were discharged with a chest tube. The POD 1 discharge group ambulated earlier (p = 0.005) and experienced no inpatient complications. Multivariate analysis reveals that operative time, time to first ambulation, and postoperative day 1 air leak were negatively associated with POD 1 discharge. Those who experienced a minor inpatient complication ambulated 5.8 h later than those who did not.
Utilization of ERAS principles can facilitate POD 1 discharge in the majority of patients undergoing robotic assisted lobectomy without an increase in complications or readmissions. Early ambulation and chest tube removal are modifiable elements of ERAS associated with POD 1 discharge.
手术加速康复（ERAS）路径应用于机器人辅助肺叶切除术中与住院时间（LOS）缩短相关。我们在一家三级转诊中心评估了不同出院组患者特征及ERAS指标的完成情况差异。
我们对一个前瞻性维护的接受机器人辅助肺叶切除治疗肺恶性肿瘤患者的ERAS数据库进行了回顾性分析。患者被分为住院时间组，术后第1天、第2 - 3天和第4天及以后。分析术前和围手术期变量、ERAS指标完成情况、并发症及再入院情况。
2018年10月至2022年8月期间，对145例连续患者进行了评估。82例（56.6%）在术后第1天出院，50例（34.5%）在术后第2 - 3天出院，13例（9.0%）在术后第4天及以后出院。术后第1天出院的患者术前肺功能更好（FEV p = 0.023，DLCO p = 0.007）且手术时间更短（p < 0.001）。大多数漏气（n = 30，54.5%）在出院时已解决；然而，25例（17.2%）出院时仍留置胸管。术后第1天出院组更早开始活动（p = 0.005）且无住院并发症。多因素分析显示，手术时间、首次活动时间及术后第1天漏气与术后第1天出院呈负相关。发生轻微住院并发症的患者比未发生者活动时间晚5.8小时。
应用ERAS原则可使大多数接受机器人辅助肺叶切除术的患者在术后第1天出院，且不增加并发症或再入院率。早期活动和胸管拔除是与术后第1天出院相关的ERAS可调整要素。
