Multimodal rehabilitation program in thoracic surgery.

One of the main principles of medicine is that advances in knowledge and technological developments lead to improvements in patient care. In the area of surgery, 2 indisputably significant advances have emerged in the last 20 years, namely, minimally invasive surgery and multimodal rehabilitation programs, also known Fast Track protocols or Enhanced Recovery After Anesthesia (ERAS) programs. The aim of both developments is the same: to minimize surgical aggression, thereby improving post-operative recovery. Comparative, validated data are available from numerous studies to show the benefits of these protocols for both patients (reduced morbidity and improved quality of life) and the healthcare system (shorter hospital stays),1 but the degree of implementation needs to be examined. ERAS protocols are in essence multidisciplinary, and a lack of coordination between the various specialist areas sometimes makes them difficult to introduce. But what are ERAS programs, exactly? To paraphrase Kehlet, the father of multimodal surgical rehabilitation, ERAS is a combination of perioperative strategies supported by evidencebased medicine and aimed at improving recovery after surgical interventions.2 ERAS protocols revisit conventional perioperative practices and evaluate the specific key points of each procedure, analyzing the scientific evidence for the perioperative management of patients undergoing major surgery, to produce guidelines for helping coordinated teams improve postoperative care. These protocols cover different phases in the care of surgical patients, and address issues such as shortening the preoperative fasting period, giving carbohydrate-rich drinks before surgery, detection of malnutrition in the preoperative period, need for preventive analgesia, early postsurgical mobilization, rapid reintroduction of oral intake of fluids and food, and prompt withdrawal of unnecessary catheters and tubes. Each of these individual measures