Recommendations of the Society of Thoracic Surgery and the Section of Cardiothoracic and Vascular Surgery of the Spanish Society of Anesthesia, Resuscitation and Pain Therapy, for patients undergoing lung surgery included in an intensified recovery program
I Garutti 1 , A Cabañero 2 , R Vicente 3 , D Sánchez 4 , M Granell 5 , C A Fraile 6 , M Real Navacerrada 7 , N Novoa 8 , G Sanchez-Pedrosa 9 , M Congregado 10 , A Gómez 11 , E Miñana 12 , P Piñeiro 9 , P Cruz 9 , F de la Gala 9 , F Quero 13 , L J Huerta 14 , M Rodríguez 15 , E Jiménez 16 , L Puente-Maestu 17 , S Aragon 18 , E Osorio-Salazar 19 , M Sitges 20 , M D Lopez Maldonado 3 , F T Rios 3 , J E Morales 5 , R Callejas 18 , S Gonzalez-Bardancas 21 , S Botella 3 , M Cortés 7 , M J Yepes 22 , R Iranzo 23 , J Sayas 17
In recent years, multidisciplinary programs have been implemented that include different actions during the pre, intra and postoperative period, aimed at reducing perioperative stress and therefore improving the results of patients undergoing surgical interventions.
Initially, these programs were developed for colorectal surgery and from there they have been extended to other surgeries. Thoracic surgery, considered highly complex, like other surgeries with a high postoperative morbidity and mortality rate, may be one of the specialties that most benefit from the implementation of these programs.
This review presents the recommendations made by different specialties involved in the perioperative care of patients who require resection of a lung tumor. Meta-analyzes, systematic reviews, randomized and non-randomized controlled studies, and retrospective studies conducted in patients undergoing this type of intervention have been taken into account in preparing the recommendations presented in this guide.
The GRADE scale has been used to classify the recommendations, assessing on the one hand the level of evidence published on each specific aspect and, on the other hand, the strength of the recommendation with which the authors propose its application. The recommendations considered most important for this type of surgery are those that refer to pre-habilitation, minimization of surgical aggression, excellence in the management of perioperative pain and postoperative care aimed at providing rapid postoperative rehabilitation.