Thoracic surgery and ERAS: A comprehensive nutrition guide for your recovery journey

Thoracic surgery is a major procedure that requires thorough preparation and adequate recovery time. The Enhanced Recovery After Surgery (ERAS) program has changed the way we care for patients, particularly when it comes to nutrition. This article will guide you on how to follow the ERAS nutritional approach, helping you stay healthier before, during, and after surgery, recover more quickly, and reduce the risk of complications.

1. The importance of proper nutrition before surgery

Nutritional status affects surgical outcomes

Eating a well-balanced diet and maintaining good health before surgery are very important, especially for major procedures such as thoracic surgery [3, 4]. If you are malnourished before surgery, you may experience more serious problems and require more time to recover [4]. Studies have shown that poor nutritional status can increase the risk of infection, delayed wound healing, and prolonged hospital stays [3, 4].

Risk of malnutrition and related health problems

Patients undergoing thoracic surgery are often more susceptible to malnutrition due to underlying conditions such as lung cancer and chronic lung disease, or because of difficulty eating and poor nutrient absorption [1, 2]. Malnutrition not only weakens the immune system but also causes muscle loss, making you weaker and making recovery after surgery more difficult [4]. This may lead to complications such as pneumonia, surgical site infection, and breathing difficulties [1, 2].

2. What is the ERAS program?

What is ERAS and what are its goals?

ERAS (Enhanced Recovery After Surgery) is a specialized, evidence-based healthcare program designed to help patients recover better after surgery [1, 3]. The main goals of ERAS are to reduce the physical stress caused by surgery, help patients regain their health more quickly, reduce complications, and shorten hospital stays [1, 2, 3]. The ERAS program was introduced in 2005 and has been widely applied to various types of surgery, including thoracic surgery [1].

Key components of ERAS in thoracic surgery

The ERAS program includes multiple steps before, during, and after surgery [1, 3]. Key components related to nutrition and recovery in thoracic surgery include:

• Assessing and optimizing nutrition before surgery: The doctor will assess your nutritional status before surgery and provide nutritional supplementation if necessary [1, 3].
• Reducing traditional fasting times: Instead of prolonged fasting, you may be allowed to drink clear fluids up to 2 hours and eat light meals up to 6 hours before anesthesia [1].
• Carbohydrate loading before surgery: Drinking carbohydrate-containing fluids before surgery helps maintain stable blood glucose levels [1].
• Appropriate fluid management: Your doctor will administer an adequate amount of fluids, avoiding both fluid overload and insufficient fluid replacement [1].
• Early mobilization: You will be encouraged to get up and move around within 24 hours after surgery [1, 2].
• Early oral intake after surgery: You will be encouraged to resume eating and drinking as soon as possible [2, 3].

3. Nutritional advice according to the ERAS program

Nutritional care within ERAS is divided into two main phases: preoperative and postoperative, with specific recommendations to support optimal recovery [3].

Preoperative phase

The goal of this phase is to optimize your health, reduce hunger and thirst, and prepare your body for surgery [3].

• Nutritional optimization: immunonutrition and carbohydrate loading
  • Nutritional assessment: You should undergo a nutritional assessment before surgery to identify any risk of malnutrition at an early stage [1, 3]. If malnutrition is identified, your doctor will guide you on oral nutritional supplementation [1].
  • Immunonutrition (IMN): For patients with malnutrition, specialized nutritional products may help reduce the risk of postoperative infection [4].
  • Carbohydrate loading: You should drink a carbohydrate-containing beverage 2–3 hours before anesthesia. This helps stabilize blood glucose levels, reduce postoperative insulin resistance, and improve comfort [1, 3].
• Reducing fasting time: Instead of fasting completely for an unnecessarily long period, you may be allowed to drink clear fluids (such as water, carbohydrate-containing beverages, or tea without milk) up to 2 hours before anesthesia and eat light food up to 6 hours before surgery [1, 2]. This helps reduce hunger and thirst while maintaining energy levels [3].

Postoperative phase

The goal of this phase is to help the digestive system resume functioning quickly and provide sufficient energy and protein for wound healing and muscle recovery [2, 3].

• Start eating and drinking early: You should begin oral intake as soon as possible after surgery, usually within a few hours, unless otherwise instructed by your doctor [2, 3]. Start with clear liquids, then gradually progress to soft foods and solid foods [2]. This helps the intestines resume activity, reduces the risk of postoperative ileus, and maintains digestive function [2].
• Nutritional support: oral nutritional supplements (ONS), enteral nutrition (EN), and parenteral nutrition (PN)
  • Oral nutritional supplements (ONS): If you cannot obtain sufficient nutrients from regular meals, ONS can be used to provide additional energy, protein, vitamins, and minerals [3].
  • Enteral nutrition (EN): For patients who cannot obtain adequate nutrition orally or are at high risk of malnutrition, the doctor may place a feeding tube (through the nose into the stomach or small intestine) to provide nutrition [3]. This should be initiated early after surgery and the amount of nutrition gradually increased according to your tolerance [2, 3].
  • Parenteral nutrition (PN): PN involves delivering nutrients directly into the bloodstream through a vein. This method is used only when you cannot receive nutrition through the gastrointestinal tract or when enteral nutrition is insufficient, particularly in patients with severe malnutrition [3].

Practical examples and key points to remember

One study showed that combining exercise and nutrition according to the ERAS program improved health outcomes and reduced complications after minimally invasive surgery for lung cancer [2]. Patients following ERAS generally passed gas and had bowel movements earlier, got out of bed earlier, had their chest drains removed earlier, and had shorter hospital stays [2].

Key points to remember:

• Always strictly follow the instructions provided by your doctor and nutrition specialist [3].
• Drink enough water to prevent dehydration and support healthy kidney function [1].
• Avoid foods that are difficult to digest, high in fat, or likely to cause bloating during the early recovery period [2].
• Monitor your weight and signs of recovery so that your diet can be adjusted appropriately [2].

4. Conclusion

The ERAS program, with a focus on optimized nutritional care before and after surgery, has demonstrated significant benefits in helping patients undergoing thoracic surgery recover more effectively. By combining preoperative nutritional measures (malnutrition assessment, carbohydrate loading, and reduced fasting time) with postoperative measures (early oral intake and appropriate nutritional support), ERAS helps patients recover more quickly, experience fewer complications, and achieve a better quality of life. University Medical Center Ho Chi Minh City encourages the application of advanced approaches such as ERAS to achieve the best possible treatment outcomes for patients.

5. Frequently asked questions (FAQ)

• Is the ERAS diet suitable for all patients undergoing thoracic surgery?
  The ERAS nutritional approach is designed to be suitable for most patients undergoing thoracic surgery. However, nutrition specialists and doctors will assess each patient's specific health condition and make appropriate adjustments.
• How long should I prepare nutritionally before ERAS surgery?
  The specific duration of nutritional preparation depends on your health condition and the type of surgery. In general, nutritional assessment and optimization may begin several weeks before surgery, while specific instructions regarding fasting and carbohydrate loading are applied during the final 24 hours before surgery [1].
• What should I do if I cannot eat enough after surgery?
  If you have difficulty eating enough after surgery, inform your healthcare team immediately. They may recommend nutritional support such as oral nutritional supplements (ONS) or enteral nutrition (EN) to ensure that you receive adequate nutrients [3].
• Are there any foods I should avoid completely?
  During the recovery period, you should avoid foods that are difficult to digest, excessively fatty or spicy, as well as carbonated or alcoholic beverages. Your doctor or nutrition specialist will provide a specific list of foods to avoid based on your condition [2].
• What role do vitamins and minerals play in recovery?
  Vitamins and minerals play an essential role in wound healing, immune function, and maintaining energy levels. The healthcare team will ensure that you receive adequate micronutrients, either through your diet or supplementation when necessary [4].

6. References

• [1] Senturk, M. (2021). Enhanced recovery after thoracic anesthesia. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC8579505/. Truy cập: 2025-12-20.
• [2] Huang, L. (2024). Effectiveness of an ERAS-based exercise-nutrition management model in enhancing postoperative recovery for thoracoscopic radical resection of lung cancer: A randomized controlled trial. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC11018229/. Truy cập: 2025-12-20.
• [3] Sanchez Leon, R. M. (2023). Optimizing Nutritional Status of Patients Prior to Major Surgical Intervention. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC10402792/. Truy cập: 2025-12-20.
• [4] Powers, B. K. (2024). Enhanced recovery after surgery (ERAS® ) Society abdominal and thoracic surgery recommendations: A systematic review and comparison of guidelines for perioperative and pharmacotherapy core items. PubMed. https://pubmed.ncbi.nlm.nih.gov/38348514/. Truy cập: 2025-12-20.
• [5] Ma, J. (2024). Perioperative nutrition management in patients with spinal tuberculosis taking ERAS measures. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC11170018/. Truy cập: 2025-12-20.

The information above is for reference purposes only and is not intended as medical advice. Please contact your doctor for detailed medical consultation.