Multidisciplinary enhanced recovery protocol pathway (ERPP) in lung cancer surgical resections; a tertiary centre experience

Introduction: The ERPP in lung cancer surgery refers to perioperative interventions aiming to reduce postoperative pulmonary complications, improve clinical outcome and enhance patient experience reported measures. Aims: To investigate the impact of a multidisciplinary integrated ERPP in lung cancer surgery on clinical outcomes and patient experience in a pragmatic clinical setting. Materials and Methods: We retrospectively studied major thoracic surgery cases performed over the last 3 years and ERPP patients’ outcomes as well as patient reported experience measures(PREMS) were compared with non ERPP patients (control). Results: During 2020-2022, 360 major thoracic surgery cases were admitted in our department (229 lobectomies, 51 pneumonectonies, 80 wedge resections). Group A (210 patients) underwent ERPP and group B (150 patients) did not. Both groups were standardised for age, comorbidities and types of resection. The multidisciplinary ERPP included interventions starting before hospital admission continuing through hospital stay and discharge in a structured stepwise approach. Mean hospital stay was 3 days (2-11 days) in Group A and 8 days (5-20 days) in Group B. Group A morbidity was 8% (atrial fibrillation, pneumonia, hospital acquired infection) versus 16% in Group B. Mortality was 0.3% (A) and 3% (B). PREMS responses were scored on 5 point scale where Group A scored overall 4.5 and Group B 3.8 (p<0.05). Conclusions: The multidisciplinary integrated ERPP is a safe perioperative strategy to improve patient outcomes and experience while receiving care. It reduces hospital stay with minimal morbidity or mortality.