Table 1 Comparison of Pre-ERAS (routine) pathway and ERAS pathway

General patient admission education introduced by video

The content included general patient admission education, instruction about ERAS principles and ERAS member responses to the patients. The specialized nurse was mainly responsible for the session. Smoking and alcohol cessation for 2 weeks and 4 weeks respectively

Perioperative respiratory training and mobilization

 No

A volumetric Incentive spirometer (HUDSON RCI 2500, TeleflexInc, USA) was provided after the agreement of the patients. The physical therapists would teach the patients and supervised the patients’ respiratory training during the in-hospital period

On the first day after the operation, the electrocardiograph monitoring will be withdrawn and the patient will get out of bed for activities under professional escort. If the patient cannot get out of bed due to pain or anesthesia, the patient will also be encouraged to sit up or stand up beside the bed

VTE management

 No standardized management

1. VTE prophylaxis education preoperative VTE assessment risk rating

2. LMWH use for VTE prophylaxis during perioperative period

3. Early mobilization after surgery

Chest tube management

1. Traditionally using 2 28-F chest tube

2. Chest tube removal after drainage volume < 200 ml

1. Small-bore chest tube (18-Floyle)

2. Drain removed < 400 ml/24 h and no air flow

Urinary catheter management

 Urinary catheter was routinely used

No urinary catheter

Postoperative pain management

 Non-standardized management

1. Specialized nurse supervised and assess the pain intensity (NRS score at 6 h, 12 h, 18 h, 24 h, 36 h, 48 h after the surgery), and based on it, adjustment of analgesics would be performed if necessary

2. Standardized protocol-based multimodal approach to post-operative analgesia

3. Specialized nurses open thoracic pain clinics, aiming at follow-up of postoperative pain

Postoperative nutrition management

 Non-standardized management

1. Early Oral Intake

2. Medium chain triglyceride (MCT) diet supported by nutriology department