Improve And Experience Discuss Of Enhanced Recovery After Surgery Procedure For Minvasive Lobectomy

Objective:To summarize the experience of enhanced recovery after surgery(ERAS)management of patients undergoing thoracoscopic lobectomy.Methods:A retrospective analysis of 629 patients undergoing thoracoscopy single lobectomy in the Department of Thoracic Surgery,First Affiliated Hospital of Soochow University from January 2018 to January 2020.The routine management group(group A,RMG)accepted normally perioperative management.The rapid recovery group(RRG)is managed through the ERAS protocols;in the RRG,the postoperative hospitalization time>72h is classified as the non-early discharge group(group B),and the postoperative hospitalization time?72h is early discharge group(C group).Among them,121 cases in group A,103 patients in group B,and 405 cases in group C.The t-test and chi-square test were used to compare the preoperative general conditions and incidence of postoperative complications,chest tube indwelling time,and postoperative pain score in the first three days,the dose of opioids in the first three days after the operation,the total amount of walk steps during the postoperative day(POD)and postoperative day 1(POD1),the length of hospital stay after surgery,and the total cost of hospitalization.Results:Among the 629 study cases,compared with the RMG,the postoperative hospital stay,complication rate,chest tube indwelling time,postoperative pain scores for the first three days,postoperative opioid doses for the first three days,the total amount of walk steps during POD and POD1,the total costs of hospitalization improved statistically(p<0.05)in RRG.Compared with group A,the postoperative pain score,the incidence of postoperative complications,the length of postoperative hospital stay,the time of chest tube indwelling,and the total costs of group C were all reduced.Compared with group A,The preoperative complications increased in the groupB,and the postoperative chest tube indwelling time,pain score,and total cost during hospitalization also have significantly decreased,but there was no significant difference in the length of hospitalization and complications rate.Compared with group B,group C had fewer comorbidities before surgery,and the postoperative hospital stay,reduced chest tube indwelling time,the incidence of postoperative complications,and the total costs were reduced.There was no difference in pain scores in the first three days after surgery in groups B and C.and the dosage of opioids in group A was significantly higher than those in groups B and C.Conclusions:1.In patients with minimally invasive lobectomy for chest surgery,perioperative rapid recovery management can reduce the incidence of postoperative complications,shorten the length of hospital stay,and reduce the total cost of hospitalization;2.Most of the patients with minimally invasive lobectomy who implemented rapid perioperative rehabilitation management were able to be discharged early within 72 hours after operation,and they were safe and reliable.Some high-risk patients cannot be discharged within 72 hours,but the incidence of grade II postoperative lung complications has decreased and they can benefit from rapid recovery management.3.? A single intercostal nerve block during the operation,?removal of the chest tube as early as possible(preferably within the first 24 hours),? the use of a perioperative COX-2 selective inhibitor,? enhanced remove as soon as possible,combined with this managements Patients with lobectomy are more effective in early discharge and rapid recovery.