Our Summary

The research paper talks about the guidelines set by the ERAS®Society, which have transformed the way patients are cared for before, during and after surgeries. The researchers reviewed these guidelines, specifically those related to abdominal and thoracic surgery, to see if there was agreement on the main elements and medicine recommendations. This is important because having clear and consistent guidelines could improve patient care by avoiding unnecessary changes in procedures.

The researchers looked at 16 ERAS® guidelines related to surgery as of May 2023. They aimed to figure out if there was agreement on each item in the guidelines, identify any gaps in the procedures suggested by ERAS®, and suggest areas for future research to fill those gaps.

They found consensus on several key items, including the need for patients to stop smoking and drinking before surgery, not requiring bowel cleaning or fasting, the use of certain medications before, during and after surgery to manage pain and prevent nausea and vomiting, the use of specific medicines to prevent blood clots, infection prevention, skin preparation, managing fluids during surgery, nutritional care, preventing ileus (a type of bowel obstruction), and controlling blood sugar.

However, the research also showed that more work needed to be done. Even though there was agreement on the choice of medications, there were still questions about the dosage, timing, and specific considerations for different types of surgeries. The researchers suggest these areas need more research to ensure the guidelines are consistent and best support patients’ outcomes.

FAQs

  1. What are the core elements agreed upon in the ERAS® Society guidelines for abdominal and thoracic surgery?
  2. What are the gaps identified in the development of the ERAS® protocol?
  3. What aspects of the ERAS® guideline core items related to pharmacotherapy choice need further research and harmonization?

Doctor’s Tip

One helpful tip a doctor might tell a patient about thoracic surgery is to follow the ERAS®Society guidelines for perioperative care, including preoperative smoking and alcohol cessation, avoiding bowel reparation and fasting, and following a multimodal analgesia regimen. Following these guidelines can help improve patient outcomes and reduce complications during and after surgery.

Suitable For

Patients who are typically recommended for thoracic surgery include those with lung cancer, esophageal cancer, mediastinal tumors, pleural diseases, chest wall tumors, and other thoracic conditions that require surgical intervention. Additionally, patients with conditions such as empyema, pneumothorax, thoracic outlet syndrome, and thoracic trauma may also be recommended for thoracic surgery. It is important for patients to be evaluated by a thoracic surgeon to determine if they are suitable candidates for thoracic surgery and to discuss the potential risks and benefits of the procedure.

Timeline

Before thoracic surgery:

  1. Patient consults with thoracic surgeon to discuss surgical options and risks.
  2. Patient undergoes preoperative testing such as blood work, imaging studies, and pulmonary function tests.
  3. Patient may undergo prehabilitation to improve physical fitness and overall health before surgery.
  4. Patient stops smoking and alcohol consumption to reduce surgical risks.
  5. Patient follows preoperative fasting and bowel preparation instructions.
  6. Patient receives preoperative counseling on the procedure and what to expect during the recovery process.

After thoracic surgery:

  1. Patient is closely monitored in the post-anesthesia care unit (PACU) for initial recovery.
  2. Patient is transferred to a hospital room for further monitoring and pain management.
  3. Patient may undergo physical therapy to aid in breathing exercises and mobility.
  4. Patient follows a specific postoperative diet plan to aid in healing and prevent complications.
  5. Patient receives postoperative pain management and nausea control medications as needed.
  6. Patient is discharged from the hospital once stable and able to continue recovery at home.
  7. Patient follows up with the thoracic surgeon for postoperative appointments and monitoring of healing progress.

What to Ask Your Doctor

  1. What specific medications will I be taking before, during, and after the surgery?
  2. How will these medications help with my recovery and pain management?
  3. Are there any potential side effects or interactions I should be aware of?
  4. Will I need to adjust any of my current medications before the surgery?
  5. How long will I need to continue taking these medications post-surgery?
  6. Will there be any restrictions on my diet or activities while taking these medications?
  7. How will my pain be managed during the recovery process?
  8. What are the potential risks and benefits of the pharmacotherapy recommendations for my specific surgery?
  9. Are there any alternative medications or treatment options available?
  10. How will my medication regimen be adjusted if there are any complications during or after the surgery?

Reference

Authors: Powers BK, Ponder HL, Findley R, Wolfe R, Patel GP, Parrish RH 2nd; Enhanced Recovery Comparative Pharmacotherapy Collaborative. Journal: World J Surg. 2024 Mar;48(3):509-523. doi: 10.1002/wjs.12101. Epub 2024 Feb 13. PMID: 38348514