Table 1. Postoperative thoracic surgery ERAS pathway.

ERAS component	Day of surgery	POD 1	POD 2
Vital signs and monitoring	Telemetry (ok to travel off telemetry)	Discontinue telemetry if stable	Discontinue telemetry if stable
	Continuous pulse oximetry	Discontinue continuous pulse oximetry if respiratory status stable Wean off oxygen if saturating >88% on room air	Discontinue continuous pulse oximetry if respiratory status stable
	Vital signs every 4 hours	Vital signs every 4 hours	Wean off oxygen if saturating >88% on room air
		Standing daily weight	Vital signs every 4 hours
			Standing daily weight
Nursing care and activity	Out of bed to chair when awake	Out of bed to chair for breakfast	Walk 2 times per shift
	Walk 2 times per shift	Walk 2 times per shift	Nurses change chest tube dressing as needed
		Nurses change chest tube dressing with dry sterile gauze (no Xeroform) as needed	Can shower with occlusive dressing over chest tube site
		Can shower with occlusive dressing over chest tube site
IV fluids, Foley, diet	Lactated Ringer’s solution at maintenance rate	Regular diet	Regular diet
	Advance diet as tolerated	Heparin-lock IV
	Heparin-lock IV line when PO intake >250 cc	Discontinue Foley catheter
	Foley catheter remains in place	Straight catheterization for bladder scan >600 cc or no void after 8 hours or symptomatic
Labs and CXR, home meds	No post-op labs	Complete blood count and Chem-10	No labs
	CXR in PACU	Portable CXR	Portable CXR if chest tube still in place
		Home med reconciliation (half dose antihypertensives)	Home med reconciliation
Chest tube	Chest tube to suction in operating room	Chest tube to water seal	Chest tube to water seal
	Chest tube to water seal in PACU	Chest tube output marked every 4 hours	Chest tube output marked every 4 hours
	Chest tube output marked every 4 hours	Resident physicians strip chest tubes	Residents strip chest tubes
	Resident physicians strip chest tubes	Consider discontinuing chest tube if no air leak and low fluid output	Consider discontinuing chest tube if no air leak and low fluid output
		Post-pull CXR 2 hours after chest tube removal	Post-pull CXR two hours after removal
Respiratory	Incentive spirometry 10 times per hour	Incentive spirometry 10 times per hour	Incentive spirometry 10 times per hour
	Acapella device	Acapella device	Acapella device
	Physiotherapy vest for high risk patients	Physiotherapy vest for high risk patients	Physiotherapy vest for high risk patients
	Duoneb and albuterol per respiratory protocol	Duoneb and albuterol per respiratory protocol	Duoneb and albuterol per respiratory protocol
Pain control and sleep	Tylenol 975 mg by PO TID	Tylenol 975 mg PO TID	Tylenol 975 mg PO TID
	Gabapentin 100 mg TID	Toradol 15 mg IV every 6 hours	Ibuprofen 400 mg with meals
	Toradol 15 mg IV every 6 hours (attending decision)	Gabapentin 300 mg TID unless somnolence or contraindicated	Gabapentin 300 mg TID unless somnolence or contraindicated
	Oxycodone 2.5, 5, or 10 mg every 3 hours as needed-base dosing off pain	Oxycodone 2.5–5 mg every three hours as needed	Oxycodone 2.5–5 mg every 3 hours as needed
	Dilaudid 0.4 or 0.8 mg every 2 hours as needed for severe pain	Benadryl 25–50 mg PO as needed for itching/sleep	Benadryl 25–50 mg PO as needed for itching/sleep
	Benadryl 25–50 mg by mouth as needed for itching/sleep	Melatonin 3 mg as needed for sleep	Melatonin 3 mg as needed for sleep
	Melatonin 3 mg as needed for sleep	IV narcotics only for breakthrough pain, no standing orders	IV narcotics only for breakthrough pain, no standing orders
Prophylaxis	Nicotine patch if smoker	Nicotine patch if smoker	Nicotine patch if smoker
	Venodyne boots	Venodyne boots	Venodyne boots
	No lovenox or subcutaneous heparin	Prophylactic subcutaneous lovenox	Prophylactic subcutaneous lovenox
	Colace 100 mg BID/senna 17.2 mg at bedtime	Colace 100 mg BID/senna 17.2 mg at bedtime	Colace 100 mg BID/senna 17.2 mg at bedtime
	Miralax as needed	Miralax as needed	Miralax as needed
	Zofran 4 mg IV/PO every 8 hours as needed for nausea	Zofran 4 mg IV/PO every 8 hours as needed for nausea	Zofran 4 mg IV/PO every 8 hours as needed for nausea
			Milk of magnesia daily if no BM
			POD4: lactulose every 6 hours if no BM
			POD6: dulcolax suppository if no BM
Consults and discharge	–	Physical therapy consult for age >60 or ECOG ≥1	Discharge planning
		Smoking cessation for current smokers
		Consider nutrition evaluation if malnourished
		Consider VNA services
		Discharge planning

ERAS, enhanced recovery after surgery; POD, postoperative day; IV, intravenous; PO, oral; CXR, chest X-ray; PACU, post-anesthesia care unit; TID, three times daily; BID, two times daily; BM, bowel movement; ECOG, Eastern Cooperative Oncology Group; VNA, Vising Nurse Association.