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Shefer N.A.

Siberian State Medical University;
Tomsk Regional Clinical Hospital

Topolnitskiy E.B.

Siberian State Medical University;
Tomsk Regional Clinical Hospital

Enhanced recovery after lung resection in high-risk patients

Authors:

Shefer N.A., Topolnitskiy E.B.

More about the authors

Journal: Pirogov Russian Journal of Surgery. 2023;(2): 21‑29

DOI: 10.17116/hirurgia202302121

Read: 2776 times

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Table of contents

ENHANCED RECOVERY AFTER LUNG RESECTION IN HIGH-RISK PATIENTS
ENHANCED RECOVERY AFTER LUNG RESECTION IN HIGH-RISK PATIENTS

To cite this article:

Shefer NA, Topolnitskiy EB. Enhanced recovery after lung resection in high-risk patients. Pirogov Russian Journal of Surgery. 2023;(2):21‑29. (In Russ.)
https://doi.org/10.17116/hirurgia202302121

Подписка 2026 Хирургия. Журнал им. Н.И. Пирогова (Pirogov Russian Journal of Surgery)
МСФ на ЯМ
Использование инфографики авторами научных работ
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Abstract:

OBJECTIVE

To study the possibilities of the ERAS program and immediate results in high-risk patients undergoing lung resection.

MATERIAL AND METHODS

The prospective study included 76 high-risk patients. All patients required lobar resection for various lung diseases. The risk of postoperative complications and mortality was stratified using the Thoracoscore and Thoracic Revised Cardiac Risk Index systems, as well as the American Society of Anesthesiologists Outcome Prediction Scale. At all perioperative stages, we assessed the possibilities for accelerated recovery and postoperative complications using the Thoracic Morbidity and Mortality System.

RESULTS

Patients were characterized by multiple comorbidities requiring long-term and individual preoperative correction. This prevented adherence to a single protocol at the outpatient stage. We intraoperatively observed severe adhesive process up to complete obliteration of pleural cavity that complicated the use of minimally invasive technologies. Lung tissue was characterized by emphysematous lesions and reduced elasticity that caused prolonged air release and formation of residual cavities. These features required two pleural drains in 42 (52.3%) cases that increased hospital-stay. Multimodal analgesia and early activation with rehabilitation were optimal elements of ERAS. Various postoperative abnormalities developed in 31 (40.8%) patients, mortality rate was 7.9% (n=6). Minor and serious complications prevailed (21 (27.6%) cases). Their correction was effective and not accompanied by fatal outcomes. Critical complications occurred in 10 (13.1%) patients and caused fatal outcomes in 6 (7.9%) cases.

CONCLUSION

ERAS protocol among high-risk patients in thoracic surgery is possible in the form of separate elements included in perioperative support.

Keywords:

accelerated recovery
high risk
lobectomy
complications

Authors:

Shefer N.A.

Siberian State Medical University;
Tomsk Regional Clinical Hospital

Topolnitskiy E.B.

Siberian State Medical University;
Tomsk Regional Clinical Hospital

Received:

23.05.2022

Accepted:

06.09.2022

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