Enhanced Recovery With Aggressive Ambulation Decreases Length of Stay in Lung Cancer Surgery.

Objective: Thoracic Enhanced Recovery with Ambulation after Surgery (T-ERAS) protocol at our institution includes ambulation into the operating room and 250-feet ambulation within 1 hour of extubation. We compared the average length of stay (LOS) between T-ERAS patients and that predicted using a validated surgical risk calculator.

Methods: We retrospectively reviewed patients undergoing lung cancer resection with minimally invasive approach from 2012 to 2022. Patients aged ≥ 18 were included if early ambulation was documented. Patient information were entered into the American College of Surgeon's National Surgical Quality Improvement Program Risk Calculator (NSQIP) to obtain the predicted LOS. Descriptive statistics, comparisons of observed versus predicted LOS (O/P ratio), and nonparametric testing were conducted.

Results: Of 940 patients reviewed, 886 met eligibility. For the study cohort, average age was 68, and 514 (58.0%) were female. By procedure, there were 631(71.2%) lobectomy, 204 (23.0%) wedge, 26 (2.9%) segmentectomy, 20 (2.3%) bilobectomy, and 5 (0.6%) pneumonectomy. The average LOS observed for the entire cohort was 1.2 days (median 1.0 day) compared to the predicted LOS of 3.4 days with the NSQIP (median 4.0). Overall, 842 (95%) of patients had LOS better than predicted (O/P ratio < 1), 19 (2.1%) had LOS as predicted (O/P ratio = 1), and 25 (2.8%) had LOS longer than predicted (O/P ratio > 1). The mean O/P ratio was 0.34.

Conclusion: Average LOS with T-ERAS protocol was 1.2 days compared to the predicted average of 3.6 days in patients undergoing minimally invasive lung cancer resections. Our study provides a potential protocol to shorten the LOS beyond what is predicted by NSQIP.