title: Enhanced recovery pathway for thoracic surgery in the UK.
abstract: BACKGROUND
  Enhanced recovery (ER) refers to a combination of perioperative interventions designed to minimise the impact of surgery on patients' recovery in order to reduce postoperative complications and to allow an early discharge reducing hospital costs.
  
  
  METHODS
  An ER protocol was established at our institution following a review of the best evidence available. We introduced a multi-disciplinary integrated perioperative pathway by engaging with every person involved, including the patients themselves. The programme was monitored using specifically-designed patients related outcome measures (PROMs).
  
  
  RESULTS
  One-hundred and fifty-four ER patients were compared with 171 controls from the year before ER was introduced. There was an 80% increase in same-day admissions, with a net gain of more than 300 patient bed-days. The ER group had a significantly higher number of procedures performed by video assisted thoracoscopic surgery (VATS) (ER, 32.9% vs. 9.4%, P=0.0001) and a lower rate of admission to the intensive care unit (ER, 5.8% versus 12.9%, P=0.04). Patients on the ER programme had a significantly reduced postoperative length of stay (mean ER, 5.2 vs. 11.7 days, P<0.0001). Patient satisfaction was higher in the ER group after a patient survey. The project resulted in a net saving of £214,000 for the Trust for the 2013/2014 financial year. We were also able to increase the number of patients who underwent thoracic surgery in 2013/2014 by 30% (159 patients) compared with 2012/2013.
  
  
  CONCLUSIONS
  The ER pathway has proven to be a safe perioperative management strategy to improve patient satisfaction and to reduce the length of hospital stay and cost after major thoracic surgery, without increasing morbidity or mortality.
authors.affiliation: Papworth Hospital, Cambridge, UK.
authors.forename: Marco
authors.initials: M
authors.lastname: Scarci
authors.affiliation: Papworth Hospital, Cambridge, UK.
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Solli
authors.affiliation: Papworth Hospital, Cambridge, UK.
authors.forename: Benedetta
authors.initials: B
authors.lastname: Bedetti
keywords: Thoracic surgery; enhanced recovery (ER)