title: An enhanced recovery pathway reduces duration of stay and complications after open pulmonary lobectomy.
abstract: BACKGROUND
  Few studies have investigated the effectiveness of enhanced recovery pathways (ERP) for lung resection. This study estimates the impact of an ERP for lobectomy on duration of stay, complications, and readmissions.
  
  
  METHODS
  Patients undergoing open lobectomy were identified from an OR database between 2011 and 2013. Beginning September 2012, all patients were managed according to a 4-day multidisciplinary ERP with written daily patient education treatment plans, multimodal analgesia, early diet, structured mobilization and standardized drain management. Pre-pathway (PRE) and post-pathway (POST) patients were compared in terms of duration of stay, complications, and readmissions.
  
  
  RESULTS
  We identified 234 patients (PRE, 127; POST, 107). Groups were similar with respect to age, gender, American Society of Anesthesiologists score, and baseline pulmonary function. Compared with the PRE group, the POST group had decreased duration of stay (median, 6 [interquartile range (IQR), 5-7] vs 7 [6-10] days; P < .05), total complications (40 [37%] vs 64 [50%]; P < .05), urinary tract infections (3 [3%] vs 15 [12%]; P < .05), and chest tube duration (median, 4 [IQR, 3-6] vs 5 [4-7] days; P < .05), with no difference in readmissions (7 [7%] vs 6 [5%]; P < .05) or chest tube reinsertion (4 [4%] vs 6 [5%]; P < .05). Decreased duration of stay was driven by patients without complications (median, 5 [IQR, 4-6] vs 6 [5-7] days; P < .05).
  
  
  CONCLUSIONS
  Implementation of a multimodal ERP for lobectomy was associated with decreased duration of stay and complications with no difference in readmissions.
authors.affiliation: Department of Surgery, McGill University, Montreal, Quebec, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montreal, Quebec, Canada.
authors.forename: Amin
authors.initials: A
authors.lastname: Madani
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montreal, Quebec, Canada.
authors.forename: Julio F
authors.initials: JF
authors.lastname: Fiore
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montreal, Quebec, Canada.
authors.forename: Yifan
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montreal, Quebec, Canada.
authors.forename: Jimmy
authors.initials: J
authors.lastname: Bejjani
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montreal, Quebec, Canada.
authors.forename: Lojan
authors.initials: L
authors.lastname: Sivakumaran
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montreal, Quebec, Canada.
authors.forename: Juan
authors.initials: J
authors.lastname: Mata
authors.affiliation: Department of Surgery, McGill University, Montreal, Quebec, Canada.
authors.forename: Debbie
authors.initials: D
authors.lastname: Watson
authors.affiliation: Department of Anaesthesia, McGill University, Montreal, Quebec, Canada.
authors.forename: Franco
authors.initials: F
authors.lastname: Carli
authors.affiliation: Department of Surgery, McGill University, Montreal, Quebec, Canada.
authors.forename: David S
authors.initials: DS
authors.lastname: Mulder
authors.affiliation: Department of Surgery, McGill University, Montreal, Quebec, Canada.
authors.forename: Christian
authors.initials: C
authors.lastname: Sirois
authors.affiliation: Department of Surgery, McGill University, Montreal, Quebec, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montreal, Quebec, Canada.
authors.forename: Lorenzo E
authors.initials: LE
authors.lastname: Ferri
authors.affiliation: Department of Surgery, McGill University, Montreal, Quebec, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montreal, Quebec, Canada. Electronic address: liane.feldman@mcgill.ca.
authors.forename: Liane S
authors.initials: LS
authors.lastname: Feldman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D019990:Perioperative Care / Q000379:methods*; D011013:Pneumonectomy; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D016896:Treatment Outcome