Can postoperative complications be reduced by the application of ERAS protocols in operated non-small cell lung cancer patients?

Akif Turna; Gizem Özçıbık Işık; Merve Ekinci Fidan; İsmail Sarbay; Burcu Kılıç; Hasan Volkan Kara; Ezel Erşen; Mehmet Kamil Kaynak

doi:10.5606/tgkdc.dergisi.2023.23514

Can postoperative complications be reduced by the application of ERAS protocols in operated non-small cell lung cancer patients?

Turk Gogus Kalp Damar Cerrahisi Derg. 2023 Apr 28;31(2):256-268. doi: 10.5606/tgkdc.dergisi.2023.23514. eCollection 2023 Apr.

Authors

Akif Turna¹, Gizem Özçıbık Işık¹, Merve Ekinci Fidan¹, İsmail Sarbay¹, Burcu Kılıç¹, Hasan Volkan Kara¹, Ezel Erşen¹, Mehmet Kamil Kaynak¹

Affiliation

¹ Department of Thoracic Surgery, Istanbul University-Cerrahpaşa Cerrahpaşa Medical Faculty, Istanbul, Türkiye.

Abstract

Background: In our study, we aimed to evaluate the length of hospital stay and complication rate of patients before and after application o f t he E nhanced R ecovery A fter S urgery ( ERAS) protocols.

Methods: Between January 2001 and January 2021, a total of 845 patients (687 males, 158 females; mean age: 55±11 years; range, 19 to 89 years) who were operated with the diagnosis of non-small cell lung carcinoma were retrospectively analyzed. The patients were divided into three groups as follows: patients between 2001 and 2010 were evaluated as pre-ERAS (Group 1, n=285), patients between 2011 and 2015 as preparation for ERAS period (Group 2, n=269), and patients who had resection between 2016 and 2021 as the ERAS period (Group 3, n=291).

Results: All three groups were similar in terms of clinical, surgical and demographic characteristics. Smoking history was statistically significantly less in Group 3 (p=0.005). The forced expiratory volume in 1 sec/forced vital capacity and albumin levels were statistically significantly higher in Group 3 (p<0.001 and p=0.019, respectively). The leukocyte count and tumor maximum standardized uptake value were statistically significantly higher in Group 1 (p=0.018 and p=0.014, respectively). Postoperative hospitalization day, complication rate, and intensive care hospitalization rates were statistically significantly lower in Group 3 (p<0.001). The rate of additional disease was statistically significantly higher in Group 1 (p=0.030). Albumin level (<2.8 g/dL), lymphocyte/monocyte ratio (<1.35), and hemoglobin level (<8.3 g/dL) were found to be significant predictors of complication development.

Conclusion: With the application of ERAS protocols, length of postoperative hospital stay, complication rate, and the need for intensive care hospitalization decrease. Preoperative hemoglobin level, albumin level, and lymphocyte/monocyte ratio are the predictors of complication development. Increasing hemoglobin and albumin levels before operation may reduce postoperative complications.

Keywords: Complication; ERAS protocols; non-small cell lung cancer; thoracic surgery.