Table 1. Example of enhanced recovery pathway for lobectomy [modified from Madani et al. (2)].

Target Intervention	Enhanced recovery pathway
Preoperative
Patient education	Standardized preoperative education protocol
	Information booklet with daily goals
Intraoperative
Analgesia	Thoracic epidural inserted
Extubation	Preferred extubation in the operating room or in the post-anesthesia care unit
Postoperative
Analgesia	Thoracic epidural stop test performed on the day the last chest tube is removed
Urinary drain	POD 1: drain removed if adequate urine output
	If no urine output after 8 hours of removal, a bladder scan is performed an urinary retention protocol is followed
Chest tube	POD 0: maintained at −20 cmH20 suction
	POD 1: remove suction
	POD 2: remove chest tube#1 if <300 mL/24 h, non-chylous and no air leak
	POD 3: remove chest tube#2 if <300 mL/24 h, non-chylous and no air leak
Nutrition	No nasogastric tube
	POD 0: clear fluid diet
	POD 1: diet as tolerate
Chest X-ray	After either chest tube suction removal or chest tube removal
	No clamp test
Mobilization	POD 0: up in chair with assistance as tolerated
	POD 1: up in chair 3 times per day for all meals + 30–60 minutes each time, ambulate in hallway 2 times per day with assistance
	POD 2: out of bed for all meals and ≥8 hours during the day, walking in hallway 17.5–35 meters 3 times per day with assistance
	POD 3: increase ambulation to 75 meters 3–5 times per day
Chest rehabilitation	Spirometry 10 times every hour while awake
	Chest physiotherapy every 4 hours
Target discharge	POD 3 if 1 chest tube
	POD 4 if 2 chest tubes

POD, post-operative day.