Enhanced recovery after chest wall resection and reconstruction: a clinical practice review.

Details

Serval ID
serval:BIB_093C253F746E
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Enhanced recovery after chest wall resection and reconstruction: a clinical practice review.
Journal
Journal of thoracic disease
Author(s)
Forster C., Jacques V., Abdelnour-Berchtold E., Krueger T., Perentes J.Y., Zellweger M., Gonzalez M.
ISSN
2072-1439 (Print)
ISSN-L
2072-1439
Publication state
Published
Issued date
30/04/2024
Peer-reviewed
Oui
Volume
16
Number
4
Pages
2604-2612
Language
english
Notes
Publication types: Journal Article ; Review
Publication Status: ppublish
Abstract
Since the late 1990s, and Henrik Kehlet's hypothesis that a reduction of the body's stress response to major surgeries could decrease postoperative morbidity, "Enhanced Recovery After Surgery" (ERAS) care pathways have been streamlined. They are now well accepted and considered standard in many surgical disciplines. Yet, to this day, there is no specific ERAS protocol for chest wall resections (CWRs), the removal of a full-thickness portion of the chest wall, including muscle, bone and possibly skin. This is most unfortunate because these are high-risk surgeries, which carry high morbidity rates. In this review, we propose an overview of the current key elements of the ERAS guidelines for thoracic surgery that might apply to CWRs. A successful ERAS pathway for CWR patients would entail, as is the standard approach, three parts: pre-, peri- and postoperative elements. Preoperative items would include specific information, targeted patient education, involvement of all members of the team, including the plastic surgeons, smoking cessation, dedicated nutrition and carbohydrate loading. Perioperative items would likely be standard for thoracotomy patients, namely carefully selective pre-anesthesia sedative medication only in some rare instances, low-molecular-weight heparin throughout, antibiotic prophylaxis, minimization of postoperative nausea and vomiting, avoidance of fluid overload and of urinary drainage. Postoperative elements would include early mobilization and feeding, swift discontinuation of intravenous fluid supply and chest tube removal as soon as safe. Optimal pain management throughout also appears to be critical to minimize the risk of respiratory complications. Together, all these items are achievable and may hold the key to successful introduction of ERAS pathways to the benefit of CWR patients.
Keywords
Enhanced Recovery After Surgery (ERAS), chest wall reconstruction, chest wall resection (CWR)
Pubmed
Web of science
Open Access
Yes
Create date
16/05/2024 15:31
Last modification date
22/06/2024 7:07
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