Evaluation of Enhanced Recovery after Surgery (ERAS) Protocol in Thoracic Lobectomy: Effects on Pulmonary Complications and Length of Hospital Stay

Background: Thoracic lobectomy remains the gold standard surgical treatment for early-stage non-small cell lung cancer (NSCLC). However, postoperative pulmonary complications (PPCs) continue to represent a major source of morbidity, prolonged hospitalization, and increased healthcare expenditure. Enhanced Recovery after Surgery (ERAS) protocols have demonstrated efficacy across multiple surgical disciplines, yet their systematic application in thoracic lobectomy remains incompletely characterized. Methods: A prospective comparative study was conducted at a tertiary thoracic surgery center. A total of 216 patients undergoing elective lobectomy for NSCLC were enrolled: 112 patients managed under the ERAS protocol and 104 patients under conventional care. Primary outcomes included PPC incidence and LOS. Secondary outcomes included 30-day readmission, mortality, chest tube duration, and pain scores. Results: The ERAS group demonstrated a significantly lower PPC rate (15.2% vs. 29.8%; p = 0.009) and shorter mean LOS (5.3 ± 1.8 vs. 8.1 ± 2.6 days; p < 0.001) compared to conventional care. Chest tube duration was reduced (2.8 ± 1.1 vs. 4.2 ± 1.7 days; p < 0.001). No significant differences in 30-day readmission rates (7.1% vs. 5.8%; p = 0.680) or mortality (0.9% vs. 1.0%; p = 1.000) were observed between groups. Conclusion: Implementation of an ERAS protocol in thoracic lobectomy significantly reduces postoperative pulmonary complications and hospital length of stay without increasing readmission or mortality rates, supporting its adoption as a standard perioperative care framework in thoracic surgery.