Background: 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


Lung cancer has always been one of the most health-threatening and fatal diseases in China, ranking the highest in morbidity and mortality among malignant diseases and causing unbearable social and economic burden globally. Among various treatments for lung cancer, surgery remains the primary or optimal approach, especially for limited stage patients.1 Due to reduced lung function and sequential postoperative pulmonary complications (PPCs), extended in-hospital stay and significant cost after surgeries are frequently required.2–4 Effective comprehensive preoperative prevention, including pulmonary rehabilitation or drug intervention for non-small cell lung cancer (NSCLC) patients, may reduce the risk of PPCs and effectively achieve optimistic clinical outcomes.5,6 Given the high incidence of cardiopulmonary comorbidities in lung cancer patients, these individuals are particularly at high risk of PPCs. In the Chinese expert consensus statement on multi-disciplinary peri-operative airway management (2016 version),7 comprehensive pulmonary rehabilitation (CPR), including physical exercise and pharmacotherapy (inhaled corticosteroid (ICS) and bronchodilator), was recommended for patients during peri-operation because it plays a vital role in enhancing cardiopulmonary capacity and subsequently decreasing PPC rates.8–10

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Clinical experiments have demonstrated the effectiveness and feasibility of pulmonary rehabilitation (PR) as a cost-effective intervention for preoperative conditioning, especially for patients with high risks of PPCs due to limited lung function.11,12 However, the appropriate rehabilitation regimen, duration, and intensity remain unclear. Only a few small randomized controlled trials (RCT) confirmed that CPR helps to shorten the hospitalization time and reduce the PPC rates in lung cancer patients; thus, evidence on the feasibility and effectiveness of CPR is limited.13–15 Furthermore, CPR outcomes in Chinese surgical lung cancer patients remain unknown and need to be explored in the real world. Our study team focused on studies concerning the effectiveness of CPR combined with physical exercise and pharmacotherapy (ICS and bronchodilators) for lung cancer patients in the peri-operation period, seeking to provide substantial evidence of the positive effect of CPR in this population.

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