Comprehensive Pulmonary Rehabilitation is an Effective Way for Better Postoperative Outcomes in Surgical Lung Cancer Patients with Risk Factors: A Propensity Score-Matched Retrospective Cohort Study

Abstract

Kun Zhou1 ,* Yutian Lai1,2 ,* Yan Wang,1 Xin Sun,3 Chunmei Mo,4 Jiao Wang,5 Yanming Wu,1 Jue Li,1 Shuai Chang,1 Guowei Che1 1Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People’s Republic of China; 2Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People’s Republic of China; 3Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People’s Republic of China; 4Medical Record Department, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People’s Republic of China; 5Rehabilitation Department, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People’s Republic of China*These authors contributed equally to this workCorrespondence: Guowei Che Tel [phone]Fax [phone]Email [email protected]: To investigate the effectiveness and cost minimization of comprehensive pulmonary rehabilitation (CPR) in lung cancer patients who underwent surgery.Patients and Methods: A retrospective observational study based on medical records was conducted, with 2410 lung cancer patients who underwent an operation with/without CPR during the peri-operative period. Variables including clinical characteristics, length of stay (LOS), postoperative pulmonary complications (PPCs), and hospitalization expenses were compared between the intervention group (IG) and control group (CG). The CPR regimen consists of inspiratory muscle training (IMT), aerobic endurance training, and pharmacotherapy.Results: Propensity score matching analysis was performed between two groups, and the ratio of matched patients was 1:4. Finally, 205 cases of IG and 820 cases of CG in the matched cohort of our study were identified. The length of postoperative hospital stay [median: 5 interquartile (4– 7) vs 7 (4– 8) days, P < 0.001] and drug expenses [7146 (5411– 8987) vs 8253 (6048– 11,483) ¥, P < 0.001] in the IG were lower compared with the CG. Additionally, the overall incidence of PPCs in the IG was reduced compared with the CG (26.8% vs 36.7%, P = 0.008), including pneumonia (10.7% vs 16.8%, P = 0.035) and atelectasis (8.8% vs 14.0%, P = 0.046). Multivariable analysis showed that CPR intervention (OR = 0.655, 95% CI: 0.430– 0.865, P = 0.006), age ≥ 70 yr (OR = 1.919, 95% CI: 1.342– 2.744, P < 0.001), smoking (OR = 2.048, 95% CI: 1.552– 2.704, P < 0.001) and COPD (OR = 1.158, 95% CI: 1.160– 2.152, P = 0.004) were related to PPCs.Conclusion: The retrospective cohort study revealed a lower PPC rate and the shorter postoperative length of stay in the patients receiving CPR, demonstrating the clinical value of CRP as an effective strategy for surgical lung cancer patients with risk factors.Keywords: pulmonary rehabilitation, thoracic surgery, lobectomy, lung cancer

Keywords

• pulmonary rehabilitation
• thoracic surgery
• lobectomy
• lung cancer