Background Enhanced recovery after surgery (ERAS) protocols have been applied in thoracic surgery and are beneficial to patients. However, some issues about ERAS are still pending.

Methods A total of 1,654 patients who underwent thoracic surgery under the guidance of ERAS protocols were enrolled in this study. We set the length of postoperative stay (LOPS) as our key research indicator. Patients were divided into routine discharge group and delayed discharge group based on LOPS. Causes of delayed discharge were analyzed to improve management of postoperative recovery.

Results Male, old age, underlying disease (coronary artery disease, chronic kidney disease, old cerebral infarction, chronic obstructive pulmonary disease, and arrhythmia), intensive care unit (ICU) stay, type of insurance, and lower forced expiratory volume in one second (FEV1) are the independent impact factors causing delayed discharge. Increased nonchylous drainage (INCD) and prolonged air leakage were the two leading causes for delayed discharge.

Conclusion Patients should have personalized recovery goal under the same ERAS protocols. We should accept that patients in poor general condition have a prolonged LOPS. More stringent ICU stay indications should be developed to increase postoperative patients' ERAS protocols compliance. Further research on chest tube management will make a contribution to ERAS protocols.

背景 加速术后恢复 (ERAS) 方案已应用于胸外科手术，对患者有益。然而，关于 ERAS 的一些问题仍然悬而未决。

方法 共纳入在ERAS方案指导下接受胸外科手术的1654例患者。我们将术后住院时间（LOPS）作为我们的关键研究指标。根据LOPS分为常规出院组和延迟出院组。分析延迟出院的原因，改进术后恢复管理。

结果 男性、高龄、基础疾病（冠状动脉疾病、慢性肾脏疾病、陈旧性脑梗死、慢性阻塞性肺疾病和心律失常）、重症监护病房（ICU）住院时间、保险类型、降低一秒用力呼气量(FEV1) 是导致延迟放电的独立影响因素。非乳糜性引流（INCD）增加和漏气时间延长是延迟出院的两个主要原因。

结论 在相同的 ERAS 方案下，患者应该有个性化的康复目标。我们应该接受一般状况不佳的患者的 LOPS 延长。应制定更严格的 ICU 停留指征，以提高术后患者对 ERAS 协议的依从性。对胸管管理的进一步研究将为 ERAS 协议做出贡献。