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Successful postoperative recovery management after thoracoscopic lobectomy and segmentectomy using an ERAS-based protocol of immediate ice cream intake and early ambulation: a 3-year study

Authors Kuroda H, Sugita Y, Watanabe K, Nakanishi K, Sakakura N, Naito Y, Sakao Y

Received 19 November 2018

Accepted for publication 12 March 2019

Published 7 May 2019 Volume 2019:11 Pages 4201—4207

DOI https://doi.org/10.2147/CMAR.S195219

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Andrew Yee

Peer reviewer comments 3

Editor who approved publication: Dr Beicheng Sun


Hiroaki Kuroda,1 Yusuke Sugita,1 Kiyoe Watanabe,2 Keita Nakanishi,1 Noriaki Sakakura,1 Yumiko Naito,2 Yukinori Sakao1

1Department of Thoracic Surgery; 2Department of Nursing, Aichi Cancer Center Hospital, Nagoya, Japan

Background: Enhanced recovery after surgery (ERAS) protocols are well known for reducing post-operative complications, facilitating early recovery and reducing hospitalization. In this study, we developed ERAS protocols involving immediate ice cream intake for checking postoperative chylothorax and subsequent early ambulation in order to investigate whether these methods have postoperative benefits.
Methods: We retrospectively evaluated 500 patients who underwent thoracoscopic segmentectomy and/or lobectomy (TSL) between January 2014 and September 2017. The patients were divided into two groups: 271 patients for Phase I and 229 for Phase II. Ice cream intake commenced during Phase I. Phase I patients were made to walk on the following day, whereas Phase II ambulate within 4 hrs after immediate ice-cream intake.
Results: The mean ice cream intake was significantly higher in Phase II than in Phase I (81.6% vs 56.1%). In Phase II, 91.2% and 94.0% were able to ambulate within 4 and 6 hrs, respectively. Minor postoperative complications (Clavien–Dindo I–II classification) were lower in Phase II (3.1%) than in Phase I (10.4%); however, we found no statistical significance (p=0.08). Multivariate analysis showed that ice cream intake and removal of chest drainage tube within 4–6 hrs significantly contributed to the reduction of hospitalization to ≤3 postoperative days (p=0.03 and p<0.01).
Conclusions: The results of this study suggested that our ERAS protocol represented by immediate ice cream intake, and early ambulation is feasible and can help in reducing postoperative complications, chest drainage duration, and hospitalization after TSL.

Keywords: ice cream, ERAS, thoracoscopy, lobectomy, segmentectomy, chylothorax

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