Articles Open access

Current perioperative anesthetic practice in thoracic surgery: a multicenter survey from high-volume centers in Southern Italy

Authors

Published
12 November 2026
Section
Articles
DOI
10.4081/aapm.2026.71

Abstract

Enhanced Recovery After Surgery (ERAS) pathways have substantially changed perioperative management in thoracic surgery by promoting evidence-based interventions throughout the surgical pathway. Nevertheless, the implementation of these recommendations remains heterogeneous across institutions, and real-world data describing contemporary anesthetic practice are limited. This study aimed to characterize current perioperative anesthetic management in thoracic surgery across major referral centers in Southern Italy. A multicenter cross-sectional survey was conducted among consultant anesthesiologists routinely involved in thoracic surgery across seven hospitals in the Campania Region, Italy. An anonymous web-based questionnaire explored perioperative management, including preoperative assessment, anesthetic techniques, one-lung ventilation (OLV) strategies, regional analgesia, and postoperative care pathways. Descriptive statistics were used to summarize current clinical practice. Forty anesthesiologists completed the survey. Most respondents (92.5%) practiced in tertiary referral centers, and 84.6% worked in hospitals performing more than 150 thoracic procedures annually. Balanced volatile anesthesia and total intravenous anesthesia (TIVA) were adopted with similar frequency. Lung-protective ventilation during OLV was universally applied, with individualized positive end-expiratory pressure (PEEP) used by most participants. Ultrasound-guided regional anesthesia was incorporated into routine practice by all respondents. Conversely, considerable variability persisted regarding postoperative organizational pathways, particularly the availability of structured respiratory physiotherapy protocols and intermediate-care facilities. Evidence-based intraoperative anesthetic strategies are now widely implemented across high-volume thoracic surgery centers in Southern Italy. In contrast, postoperative organizational pathways remain heterogeneous, suggesting that future quality-improvement initiatives should primarily focus on multidisciplinary implementation of ERAS recommendations and standardization of postoperative care.

Keywords

Ethics Approval

This study was conducted in accordance with the Declaration of Helsinki. Since this study involved an anonymous, voluntary online survey with no risk to participants, formal institutional review board or ethics committee approval was waived. Written consent to participate was obtained from all study participants.

Data Availability Statement

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

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Copyright (c) 2026 Marco Rispoli, Francesca Bifulco, Antonio Di Fuccia, Bernardo Fralicciardi, Francesco Frezza, Giacomo Torretta, Francesco Coppolino

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