Enhanced recovery after surgery in elderly patients with non-small cell lung cancer who underwent video-assisted thoracic surgery

Table 1 Perioperative management

	Measures	Routine care	ERAS
Preoperative	Education	Routine preoperative education	ERAS education
	Diet	Fasting for 6 h	Drink 1000 mL of 10% glucose the night before surgery; drink 200 mL of 10% glucose 2 h before surgery
	Sedatives (to improve sleep)	Yes	Yes
Intraoperative	Indwelling catheter after anaesthesia	Yes	Yes
	Temperature maintenance	No	Yes
Postoperative	Analgesia	Patient-controlled epidural analgesia	Use of NSAIDs for 48 h
	Infusion volume	Total intravenous infusion during the first 24 h after the operation < 1500 mL, infusion rate 20-30 mL/min; vasoconstrictors may be used in the case of hypotension or urine output < 20 mL/h	Rapid intravenous drip of 250 mL of saline within 1 h; the remaining parameters were the same as those in the routine care group
	Diet during the first 6 hours after the operation	A small amount of water	400 mL of liquid food
	Promote bowel movements	No	Chewing gum
	Catheter removal	24 h after the operation	12 h after the operation
	Early exercise	Patient choice	Lower limb movements

NSAIDs: Non-steroidal anti-inflammatory drugs.

Table 2 Patient education

Patient preoperative education
Pre-operative	Be familiar with the environment and hospitalization process
	Preoperative nutritional risk screening
	Eat a healthy diet & stay active (1-2 wk before surgery)
	Normal diet the day before surgery
	Drink moderate glucose 2 h before surgery
	Preventive use of antibiotics
Postoperative	Eating liquid food moderately within six hours after surgery & infusion
	Receive any necessary medications
	Removed catheter at 12 h after operation
Day after surgery	Normal diet
	Use mixture of non-narcotic pain medication to keep comfortable
	Get out of bed as soon as possible
	Try to cough and expectorate

Table 3 Baseline data

Baseline data		Before the match (n = 412)			After match (n = 170)
		Routine care (n = 327)	ERAS (n = 85)	P value	Routine care (n = 85)	ERAS (n = 85)	P value
Age		72.18 ± 4.53	72.91 ± 4.94	0.22	72.55 ± 5	72.91 ± 4.94	0.643
Sex	Male	215	56	0.982	59	56	0.624
	Female	112	29		26	29
BMI (kg/m2)		22.54 ± 2.69	22.73 ± 2.62	0.54	22.51 ± 2.4	22.73 ± 2.62	0.565
FEV1 (L)		3.21 ± 0.45	3.24 ± 0.41	0.615	3.24 ± 0.41	3.24 ± 0.41	0.983
Pathological classification	Adenocarcinoma	261	69	0.78	69	69	1
	Squamous cell carcinoma	66	16		16	16
TNM stage	I	235	55	0.198	55	55	1
	II	92	30		30	30
Surgical approach	Uniportal VATS	282	69	0.242	75	69	0.201
	Three ports VATS	45	16		10	16
Scope of resection	Pulmonary wedge	66	14	0.64	14	14	1
	Lung segment	86	21		21	21
	Lobectomy	175	50		50	50

ERAS: Enhanced recovery after surgery; BMI: Body mass index; FEV1: Forced expiratory volume in the first second; TNM: Tumor-node-metastasis; VATS: Video-assisted thoracic surgery.

Table 4 Clinical outcome measures (scope of resection subgroup analysis)

Outcome Measures	Total (n = 170)			Pulmonary wedge (n = 28)			Segmentectomy (n = 42)			Pulmonary lobe (n = 100)
	ERAS (n = 85)	Routine care (n = 85)	P value	ERAS (n = 14)	Routine care (n = 14)	P value	ERAS (n = 21)	Routine care (n = 21)	P value	ERAS (n = 50)	Routine care (n = 50)	P value
Postoperative hospital stay (d)	6.06 ± 2.07	6.61 ± 1.68	0.024	5.43 ± 1.91	6.14 ± 1.99	0.352	5.9 ± 2.51	6.29 ± 1.65	0.325	6.3 ± 1.91	6.88 ± 1.59	0.040
Total hospital expenses (CNY)	42757.63 ± 14963.16	53748.72 ± 18356.11	0.000	37812.08 ± 13327.54	41836.7 ± 13282.69	0.454	39187.44 ± 18933.83	51245.25 ± 16865.5	0.007	45641.86 ± 13016.75	58135.55 ± 18757.68	0.001
Postoperative 48-h pain score	2.38 ± 0.91	2.59 ± 0.88	0.109	2.29 ± 0.83	2.43 ± 0.76	0.667	2.33 ± 1.11	2.48 ± 0.87	0.560	2.42 ± 0.86	2.68 ± 0.91	0.135
Satisfaction score	80.65 ± 7.74	76.67 ± 7.1	0.001	80 ± 7.99	77 ± 6.86	0.427	80.29 ± 7.12	76.9 ± 5.66	0.130	80.98 ± 8.04	76.48 ± 7.79	0.003
Readmission within 30 d	0	1	1.000	0	0		0	0		0	1	1.000
Complications (n)	14	26	0.030	2	2	1.000	5	12	0.028	7	12	0.065
Air leakage	7	13	0.153	1	1	1.000	3	7	0.277	3	5	0.712
Atelectasis	2	4	0.678	0	0		1	2	1.000	1	2	1.000
Pulmonary infection	3	6	0.493	1	1	1.000	1	1	1.000	1	4	0.359
Atrial fibrillation	1	2	1.000	0	0		0	1	1.000	1	1	1.000
Arrhythmia	1	1	1.000	0	0		0	1	1.000	1	0	1.000

ERAS: Enhanced recovery after surgery.

Table 5 Clinical outcome measures (age subgroup analysis)

Outcome measures	Total (n = 170)			Age 60-73 (n = 28)			Age 74-80 (n = 42)
	ERAS (n = 85)	Routine (n = 85)	P value	ERAS (n = 14)	Routine care (n = 14)	P value	ERAS (n = 21)	Routine care (n = 21)	P value
Postoperative hospital stay (d)	6.06 ± 2.07	6.61 ± 1.68	0.024	5.96 ± 2	6.57 ± 1.7	0.057	6.18 ± 2.17	6.67 ± 1.69	0.188
Total hospital expenses (CNY)	42757.63 ± 14963.16	53748.72 ± 18356.11	0.000	42122.76 ± 13923.83	52334 ± 18206.28	0.008	43471.85 ± 16202.51	55417.37 ± 18628.5	0.001
Postoperative 48-h pain score	2.38 ± 0.91	2.59 ± 0.88	0.109	2.33 ± 0.83	2.8 ± 0.83	0.006	2.43 ± 1.01	2.33 ± 0.87	0.687
Satisfaction score	80.65 ± 7.74	76.67 ± 7.1	0.001	81.16 ± 7.52	76.78 ± 6.31	0.004	80.08 ± 8.04	76.54 ± 8.01	0.055
Readmission within 30 d	0	1	1.000	0	0		0	1	1.000
Complications (n)	14	26	0.030	5	11	0.109	8	15	0.071
Air leakage	7	13	0.153	4	5	1.000	3	8	0.179
Atelectasis	2	4	0.678	1	2	1.000	1	2	0.982
Pulmonary infection	3	6	0.493	1	3	0.625	2	3	0.977
Atrial fibrillation	1	2	1.000	0	1	1.000	1	1	1.000
Arrhythmia	1	1	1.000	0	0		1	1	1.000

ERAS: Enhanced recovery after surgery.