Moderne perioperative Versorgungskonzepte in der Thoraxchirurgie: Enhanced Recovery After Thoracic Surgery (ERATS)

Zusammenfassung

Bei den modernen perioperativen Versorgungskonzepten ermöglicht das multimodale ERAS (Enhanced Recovery After Surgery) eine Verbesserung der postoperativen Rekonvaleszenz von chirurgischen Patienten nach einem operativen Eingriff. Es wird durch die sog. ERAS-Society geleitet und Kliniken können sich offiziell zertifizieren lassen. Der Schwerpunkt des ERAS-Konzepts liegt in einer einheitlichen Betreuung des Patienten bereits vor der Aufnahme bis zur Entlassung mit dem Ziel einer Verbesserung der perioperativen Abläufe durch Implementierung von evidenzbasierten Protokollen unter Beteiligung eines multidisziplinären Behandlungsteams. Im Jahr 2019 erschienen erstmalig ERAS-Guidelines der europäischen Gesellschaft für Thoraxchirurgie (ESTS = European Society of Thoracic Surgery) in Kooperation mit der ERAS-Society speziell für lungenresezierende Eingriffe, welche insgesamt 45 Empfehlungen bzw. Enhanced Recovery Pathways (ERP) unterschiedlicher Graduierung definierten. Durch die Implementierung von ERAS-Konzepten in der Thoraxchirurgie (ERATS = Enhanced Recovery After Thoracic Surgery) sollen standardisierte perioperative Abläufe basierend auf Studienergebnissen und/oder Expertenempfehlungen etabliert werden. Diese Empfehlungen berücksichtigen neben organisatorischen Aspekten vor allem thoraxchirurgische und anästhesiologische Vorgehensweisen mit dem übergeordneten Ziel, einen strukturierten, auf den Patienten zugeschnittenen Behandlungsplan zu erstellen. Durch all diese Maßnahmen soll ein multimodales Gesamtkonzept entstehen, das primär zu einem verbesserten Outcome nach elektiven lungenresezierenden Eingriffen und sekundär zu kürzeren Krankenhausaufenthaltsdauern mit entsprechend geringen Kosten führen soll.

Ziele dieses Übersichtsartikels sind neben der Beschreibung grundlegender ERAS-Prinzipien vor allem die kompakte Darstellung der aus Sicht der Autoren wichtigsten europäischen ERAS-Empfehlungen für lungenresezierende Operationen sowie deren Anwendung bzw. Umsetzung in der deutschen Thoraxchirurgie.

Abstract

In modern perioperative care concepts, multimodal ERAS (Enhanced Recovery After Surgery) is a multimodal perioperative treatment concept for improving postoperative recovery of surgical patients after an operation. This is managed by the so-called ERAS Society and through which hospitals can also be officially certified. The focus of the ERAS concept is on uniform patient care from admission to discharge, with the aim of improving perioperative processes by implementing evidence-based protocols involving a multidisciplinary treatment team. In 2019, ERAS guidelines were published for the first time by the European Society of Thoracic Surgery (ESTS), in cooperation with the ERAS Society, for specific lung resection procedures, and these identified a total of 45 graduated recommendations or Enhanced Recovery Pathways (ERP). The implementation of ERAS concepts in thoracic surgery (ERATS = Enhanced Recovery After Thoracic Surgery) is intended to establish standardised perioperative procedures based on study results and/or expert recommendations. These recommendations take into account organisational aspects as well as thoracic surgical and anaesthesiological procedures, with the overriding goal of creating a structured treatment plan tailored to the patient. All these measures should result in a multimodal overall concept, which should primarily lead to an improved outcome after elective thoracic surgery and secondarily to shorter hospital stays with correspondingly lower costs.

This review article describes basic ERAS principles and provides a compact presentation of the most important European ERAS recommendations from the authors’ point of view, together with typical obstacles to the implementation of the corresponding ERATS program in German thoracic surgery.

Schlüsselwörter

ERAS - Fast Track - perioperative Medizin - Thoraxchirurgie

Keywords

ERAS - fast track - perioperative medicine - thoracic surgery

• Literatur

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