Higher Enhanced Recovery Adherence is Associated With Shorter Length of Stay and Fewer Complications After Lung Resection.

[OBJECTIVES] Enhanced Recovery After Thoracic Surgery (ERATS) protocols aim to standardize perioperative care and improve outcomes in lung cancer surgery. This study evaluated the association between ERATS protocol adherence and outcomes, primarily length of stay (LOS), in patients undergoing anatomical lung resection.

[METHODS] The ERATS trial was a prospective, multicentre implementation study across 10 Dutch centres (2020-2023). Adult patients (≥18 years) undergoing anatomical lung resection were included. Adherence to 22 ERATS elements was assessed dichotomously and summarized as a composite ERATS score (0%-100%). Linear regression analysis was used to evaluate the association between ERATS score and log-transformed LOS, logistic regression for complications, readmissions, and mortality. Models were adjusted for clinical covariates.

[RESULTS] A total of 727 patients were analysed (median age 67 years; 49.4% male). Median LOS: 4 days (interquartile range [IQR] 3-6). Complications occurred in 32.3% (7.4% Clavien-Dindo III-IV); 30- and 90-day mortality were 1.1% and 2.6%, respectively. Mean ERATS score was 63.5% (SD 13.8). Higher adherence was significantly associated with progressively shorter LOS (B = -0.012, P < .001), corresponding to a 21.3% reduction (≈0.85 days at median LOS) per 20-point increase. Higher scores were also associated with fewer complications (odds ratio [OR] = 0.982, 95% confidence interval [CI], 0.969-0.995, P = .007), a 30.5% reduction per 20-point increase.

[CONCLUSIONS] Higher ERATS adherence was associated with shorter hospital stay and fewer complications. Future efforts should focus on improving compliance-particularly with high-impact elements-to optimize recovery in lung cancer surgery.

[CLINICAL TRIAL REGISTRATION] NL-010060.