Standardized Recommendations for the Implementation of Enhanced Recovery Protocols in Thoracic Surgery in Spain: A Delphi Consensus Study

This study used a two-round Delphi consensus process with multidisciplinary experts, including thoracic surgeons, anesthetists, nurses, physiotherapists, and patients, to create a structured set of 62 enhanced recovery after surgery (ERAS) recommendations specific to thoracic surgery. Consensus was achieved for most measures across the perioperative continuum, including preoperative interventions (such as structured prehabilitation), intraoperative strategies (such as multimodal, opioid-sparing analgesia and minimally invasive approaches), and postoperative care (such as early chest drain removal and early mobilization). These recommendations integrate evidence and expert opinion to standardize perioperative pathways and reduce variability in care. This work is important to the global cardiothoracic surgery community because it provides a comprehensive, consensus-based framework to optimize perioperative care, improve clinical outcomes, and enhance recovery for patients undergoing lung and other thoracic procedures. Its adoption could help reduce complications, shorten hospital stays, and improve patient-centered care worldwide.