Enhanced recovery after surgery (ERAS ® ) protocol adapted to the Brazilian reality: a prospective cohort study for thoracic patients

Enhanced recovery after surgery (ERAS ® ) protocol adapted to the Brazilian reality: a prospective cohort study for thoracic patients

In Low-Middle Income Countries (LMICs), resource optimization and infrastructure availability are recurrently in debate. In order to assist the development and implementation of guidelines, LMICs often exemplify from High-Income Countries protocols. At the final, it will be: content adaption is ofte...

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Bibliographic Details
Published in:Journal of thoracic disease Vol. 13; no. 9; pp. 5439 - 5447
Main Authors: Abrão, Fernando C, Araujo de França, Sabrina, de Abreu, Igor R L B, das Neves Pereira, João Carlos, Del Massa, Emílio C, Oliver, Andréa, Cavalcante, Maria Gabriela C
Format: Journal Article
Language:English
Published: China AME Publishing Company 01-09-2021
Subjects:
Original
Enhanced recovery after surgery (ERAS)
lobectomy
perioperative management
pulmonary resection
thoracic surgery
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Summary:In Low-Middle Income Countries (LMICs), resource optimization and infrastructure availability are recurrently in debate. In order to assist the development and implementation of guidelines, LMICs often exemplify from High-Income Countries protocols. At the final, it will be: content adaption is often needed. In this study, we demonstrated the preliminary analysis of the Brazilian experience by adapting the ERAS Protocol for thoracic surgery patients (PROSM). Patients' data were extracted from the surgical group database that operated in the city of Sao Paulo. Patients' data were organized for analysis after the institution's ethics committee gave their approval. Patients' variables were analyzed and compared to a control group. Subgroup analysis included patients without ICU Admission. PROSM patients had reduced ICU length of stay (LOS) (Mean of 0.3±0.58 days, 1.2±1.65 days, P=0.001), Hospital LOS (Mean of 1.6±1.32 days, 3.9±3.25 days, P=0.001) and Chest Drain duration (Median 1.0±1.00 days, 3.0±3.00 days, P=0.001). Analyses of patients that were not admitted to the ICU demonstrated reduced Hospital LOS and Chest drain duration. Cost analysis, such as procedure, daily, and post-surgical costs were also significantly lower towards PROSM group. This study revealed important aspects for improvement of the delivered care quality and opportunity for expenditure management. We expect to assist more countries to improve knowledge under the implementation of enhanced protocols.
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Contributions: (I) Conception and design: FC Abrão, IRLB de Abreu, JC das Neves Pereira, MGC Cavalcante; (II) Administrative support: FC Abrão, IRLB de Abreu, JC das Neves Pereira, EC del Massa; (III) Provision of study materials or patients: FC Abrão, IRLB de Abreu, JC das Neves Pereira, EC del Massa, A Oliver, MGC Cavalcante; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.
ORCID: 0000-0003-2682-4537.
ISSN:2072-1439
2077-6624
DOI:10.21037/jtd-21-920