Enhanced recovery in thoracic surgery: A propensity-score matched cohort study

Abstract

BACKGROUND: Effects of the enhanced recovery (ER) pathway in patients undergoing major lung resections are still debated. AIM: We studied the effect of ER in patients undergoing major lung resections and compared the data with a standard care cohort. METHODS: We collected prospectively data of patients who underwent major lung resection from 2013 to 2015 in our institution. ER patients were compared with patients who had standard postoperative care. Propensity-scores were estimated with multiple logistic-regressions based on potential confounding variables. After propensity-score matching, data of groups were compared with paired Student9s t-test, Pearson9s χ 2 and Fisher9s exact test. R (version 3.2.3) was used for statistical analyses. RESULTS: 433 patients underwent major lung resection with standard postoperative care and 176 were ER patients. Mortality was lower in the ER group (0.6% vs. 2.3%). Major complications and median length-of-hospital stay were significant lower in the ER group (respectively 24% vs. 30%, p=0.014 and 5 vs. 8 days, p=0.024). After propensity-score matching, the difference in primary outcome measure was still statistically significant. Postoperative pain score was significantly reduced in the ER group (p=0.004). The ER group has a time ratio reduction of 0.76 in the mean length of stay compared to standard group (p=0.045). Multivariable logistic regression confirmed the significant association between ER and hospital stay (OR=0.60, 95% CI=0.48–0.73, p CONCLUSION: The ER pathway for major lung resection surgery leads to a reduction of in hospital length of stay and is associated with fewer postoperative complications, lower mortality and lower postoperative pain.