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“Enhanced recovery after surgery” (ERAS) is a patient-focused approach to thoracic surgery—long before a heart, lung, or esophageal procedure even begins. ERAS is a protocol followed in MedStar Health surgery departments that ensures we efficiently coordinate hospital processes, better prepare patients for surgery, and get patients home as soon as possible.
We follow these steps because we understand that home is the best place to heal, physically and mentally. Being in the hospital can be an overwhelming experience that detracts from healing. It’s easier to be active when you’re not in a hospital bed and having family and friends by your side to help is ideal.
Almost all post-operative patient concerns can be handled by telephone. So, we’re happy to send patients home when it is safe for them to do so.
Research shows that following ERAS protocols can shorten recovery time and reduce complications by 30-50%. In thoracic surgery specifically, research has shown that ERAS can:
- Lower the likelihood of heart and lung complications
- Reduce opioid pain medication usage
- Minimize fluid overload
- Shorten length of hospital stay
To achieve such powerful benefits, ERAS requires the participation of providers throughout the hospital as everyone comes together to optimize the patient’s thoracic surgery experience.
Planning and preparing for recovery success.
ERAS is based on a foundation of evidence-based care, collaboration between providers, and an ongoing assessment of these practices for continuous improvement. Developed by a Danish surgeon in the 1990s, evidence-based ERAS protocols help reduce stress response, limit pain, optimize physiology, and encourage quicker recovery.
For patients who need thoracic surgery, ERAS protocols bring together many teams and services to help improve preparation and recovery. Together, we discuss with the patient which services they will need for optimal recovery. Some of these services include:
- Pre-admission patient counseling
- Pre-surgical nutrition education
- Non-opioid pain management
- Types of anesthesia
- Early mobility and respiratory therapy
- Early catheter removal
One critical discussion the team has is which surgical method to use. Many thoracic procedures can be done with minimally invasive and robotic assistance. These procedures require smaller incisions and typically result in faster recovery—we use these techniques whenever possible to improve patients’ outcomes.
Improving recovery with minimally invasive surgery.
Minimally invasive surgery is performed using small incisions through the skin. A thin, tube-like instrument with a light and a tiny camera called a thoracoscope is inserted through the incision to allow the surgeon to see inside the body. Through that tube, the surgeon uses tiny surgical instruments and video monitor to perform the procedure. When the surgery is done, the small incisions are closed with just a few stitches.
Robotic surgery is also performed through small incisions. Most robotic surgeries use a computerized system with a tiny camera and mechanical arms with attached surgical instruments. These flexible, precise systems allow surgeons to perform complicated procedures that might otherwise be difficult or impossible.
Nearly all thoracic surgeries at MedStar Washington Hospital Center are performed with these techniques. Compared to traditional surgery, patients experience:
- Faster recovery
- Less pain and scarring
- Reduced damage to healthy tissue
When combined with ERAS steps to manage discomfort—such as non-narcotic pain medication—patients can breathe easier, walk sooner, and return to daily activities faster than ever.
Working together to improve recovery.
Collaboration is key to successfully implement ERAS. Bringing together a team of specialties with different perspectives results in better patient outcomes. ERAS reinforces this work by ensuring each patient’s whole-person health is at the center of the process.
We unite specialists who can help with any underlying conditions a patient might have. For example, a thoracic surgery team might include insights from a rheumatologist or orthopaedic specialist, depending on the patient’s needs.
We’re always innovating for our patients, and ERAS in thoracic surgery is one example. These protocols help our patients experience less stress and pain, heal better, recover faster, and get back to their lives.
