Preoperative Pulmonary Rehabilitation Research Articles

Effectiveness of preoperative and perioperative pulmonary rehabilitation nursing program for the management of patients undergoing thoracic surgery: A systematic review and meta-analysis.

Several studies have investigated the effectiveness of preoperative or perioperative pulmonary rehabilitation in thoracic surgery patients, but the results are inconsistent and inconclusive. This study attempts to summarize the existing data on the effect of the preoperative and perioperative pulmonary rehabilitation nursing program for the management of patients undergoing thoracic surgery. Systematic search was done in PubMed Central, SCOPUS, EMBASE, MEDLINE, Google Scholar, and ScienceDirect for papers published until December 2022 and reporting data of postoperative complications and pulmonary health status in patients undergoing thoracic surgery and receiving preoperative or perioperative pulmonary rehabilitation nursing intervention or standard care. Meta-analysis was done by random-effects model and pooled standardised mean differences (SMD) or odds ratios (OR) along with 95% confidence intervals (CIs) were reported. Eighteen studies were included and analysed. Pooled SMD was 0.44 (95%CI: -0.21 to 1.08) for forced expiratory volume (FEV-1), -0.34 (95%CI: -0.94 to 0.26) for peak expiratory flow (PEF), 0.61 (95%CI: -0.60 to 1.81) for forced vital capacity (FVC), 0.42 (95%CI: -0.13 to 0.98) for diffusing capacity of carbon monoxide (DLCO). Pooled SMD for length of hospital stay was -0.64 (95%CI: -1.09 to -0.19). Pooled OR was 0.87 [95%CI: 0.32 to 2.37] for all-cause mortality, 0.35 [95%CI: 0.25 to 0.50] for postoperative pulmonary complications, 0.98 [95%CI: 0.45 to 2.12] for respiratory failure, 0.52 [95%CI: 0.38 to 0.78] for pneumonia and 0.50 [95%CI: 0.33 to 0.76] for atelectasis. Perioperative pulmonary rehabilitation nursing program is effective in reducing the postoperative lung complications and shortening the length of hospital stay in patients undergoing thoracic surgery.

Pre-treatment optimisation with pulmonary rehabilitation of elderly lung cancer patients with frailty for surgery

ObjectiveFrailty develops as a result of age-related decline in many physiological systems and is associated with increased vulnerability to adverse outcomes following thoracic surgery. We prospectively tested our hypothesis that pre-operative pulmonary rehabilitation (Prehab) improves frailty, as suggested by a frailty index > 3 (FI > 3) and fitness, and thereby reduces the risk of post-surgical complications and death in vulnerable elderly lung cancer patients.Methods221 surgical patients, 80 with FI > 3 vs. 141 patients with FI < 3, following Prehab proceeded to surgery. Their Frailty index (FI), dyspnoea scores, performance status (PS), level of activity (LOA) and six-minute walk test (6MWT) prior to and following Prehab were determined. The post-operative length of hospital stay (LOHS), complications, mortality and mid-term survival at 1100 days were compared. Similarly, outcomes for elderly patient ≥ 70 years with FI > 3 (≥ 70,FI > 3) were compared with younger patients < 70 years with FI ≤ 3 (< 70,FI ≤ 3).ResultsPatients with FI > 3 were significantly older, had lower 6MWT and higher thoracoscores hence, 82.5% of patients with FI > 3 vs. 33.3% (p = 0.02) with FI ≤ 3 were considered high risk for surgery and postoperative adverse events. With Prehab there was significant improvement in the FI, dyspnoea scores, PS, LOA and 6MWT. Following surgery, there were no differences in major complication rates (8.8% vs. 9.2% p = ns); LOHS median (IQR) [7 (6.8) vs. 8 (5.5) days]; mortality at 30-days (3.7% vs. 0.7%, p = ns); 90-days (6.3% vs. 2.8%, p = ns) and 1-year survival (81.1% vs. 83.7% p = ns). Survival at 1100 days was (63.2% vs. 71.1%, p = 0.19). Likewise, 87.7% elderly ≥ 70,FI > 3 patients were considered high-risk for surgery and postoperative adverse events vs. 35.1% younger patients < 70,FI ≤ 3 (p = 0.0001). Following Prehab and surgery, there were no significant differences in complications, LOHS, mortality at 365 days between the two groups. Survival at 1100 days for ≥ 70,FI > 3 was 55.2% vs. 79.96% for < 70,FI ≤ 3; (p = 0,01).ConclusionOur study suggests that Prehab optimises vulnerable high-risk elderly lung cancer patients with frailty allowing them to undergo surgery with outcomes of post-surgical complications, LOHS and mortality at 365 days no different to patients with no frailty. However, mid-term survival was lower for elderly patients with frailty.

Preoperative pulmonary rehabilitation in medical inoperable patients with early stage non-small cell lung cancer and postoperative results

Aims: The impact of postoperative complications after surgery for lung cancer is substantial, with the increasing age of patients and the presence of comorbidities. Impairment in exercise capacity is a potential modifiable risk factor for postoperative complications. This study aimed to assess the contribution of preoperative pulmonary rehabilitation (PR) for increasing operability conditions in non-small cell lung cancer (NSCLC) for patients with limited pulmonary functions and postoperative results.&#x0D; Methods: The patients with NSCLC who had preoperative pulmonary rehabilitation and underwent surgical resection in our clinics between 2010-2019 were evaluated retrospectively. The patients enrolled in a comprehensive, multidisciplinary, supervised outpatient 10-day duration PR program preoperatively, consisting of bronchial hygiene, breathing control, energy conservation techniques, exercise training (endurance and strength), psychological support, and nutritional support. Exercise capacity and VO2 peak were evaluated by using an incremental shuttle walk test (ISWT).&#x0D; Results: Eighteen patients who underwent surgery due to NSCLC and had a pre-operative pulmonary rehabilitation program were evaluated. All the cases were male; the mean age was 66.2 (53-77) years. The squamous cell/adenocarcinoma ratio was 2.6 (13:5), and the mean tumor size was 4.6 (8-18) cm. The postoperative hospital stay was 12.7 (4-42) days, and they were followed up for an average of 30.2 (2-83) months. &#x0D; Conclusion: Complete surgical resection is the most effective curative treatment for lung cancer. However, many patients with lung cancer also have severe COPD, increasing their risk of postoperative complications and their likelihood of being considered "inoperable." Preoperative pulmonary rehabilitation (PR) has been proposed as an intervention for risk modification and to decrease surgical morbidity and mortality. The results of our study also revealed the importance of preoperative pulmonary rehabilitation in centers where lung cancer surgery was performed.

KINE PREOP : réhabilitation préopératoire libérale et chirurgie thoracique pulmonaire

Prehabilitation preceding oncological thoracic surgery according to a fast-track enhanced recovery after surgery (ERAS) protocol is in full expansion. Many recent studies have demonstrated the benefits of preoperative pulmonary rehabilitation as a means of reducing postoperative pulmonary complications. Unfortunately, it is rarely carried out by independent physiotherapists, and questions arise: is it feasible in private practice? Can it yield results similar to those achieved in institutional settings? The study was non-interventional. The patients included had to be able to practice physical activities according to a standard ERAS approach. The endpoints were: postoperative pulmonary complications, physical condition (VO2max), and impact on the quality of life (SF-36 questionnaire). A statistical study was conducted to analyze the results with parametric and non-parametric tests. Between June 2018 and January 2019, nine patients were included. From two to fifteen pulmonary rehabilitation sessions were carried out by six volunteering independent physiotherapists. Only two minor postoperative complications ensued. VO2max post rehabilitation increased on average by 2.4mL.kg -1.min-1. The SF-36 physical score increased significantly (+17.9%). The physical functioning (PF) (+28.9), physical restrictions (PR) (+11.1) and vitality (VT) (+16.7) sub-scores likewise improved. Based on a literature review and on comparisons, our results seem promising. While further investigations are needed, it would seem that prehabilitation by independent physiotherapists leads to results similar to those achieved in inpatient prehabilitation.

Preoperative Pulmonary Rehabilitation to Prevent Postoperative Pulmonary Complications following Open Heart Surgery: A Narrative Review

Background: Numerous medical disciplines have recognized the preoperative period as a crucial phase to enhance patient recovery and outcomes. Patients perform preoperative pulmonary rehabilitation with inspiratory or expiratory muscle training to enhance lung protection. Despite the variety of breathing techniques in the clinical setting, the literature lacks a conclusive evidence regarding which technique is more effective. Research question: In adult patients undergoing open heart surgeries, is preoperative pulmonary rehabilitation of benefit in preventing postoperative pulmonary complications, shorten length of stay in the intensive care unit (ICU) or hospital? Methods: The authors conducted a search in electronic databases regarding the current evidence of preoperative pulmonary rehabilitation. Subjects: Patients undergoing Coronary Artery Bypass Grafts (CABG) and/or valvular surgery. Intervention: Any pulmonary intervention, such as incentive spirometer, inspiratory muscle training, exercise training or relaxation, delivered prior to surgery, single or combined. Outcome measures: The incidence of persistent post-concussion symptoms (PPCSs), pulmonary function test (PFT), ventilation period, length of stay in ICU and hospital Results: The authors conducted an initial search in the systematic reviews, which yielded 16 published articles. Furthermore, the authors search in the randomized controlled trials and this yielded 72 articles. The relevancy of the selected publications was determined by reviewing their titles, keyword, and abstracts. Overall a total of eight randomized controlled trials (RCTs) and six systematic reviews involving 3908 participants were included in this review. Conclusion: Preoperative pulmonary rehabilitation utilizing various breathing techniques reduces the incidence of postoperative pulmonary complications. Keywords Preoperative Care, Breathing Exercises, Postoperative Complications, Coronary Artery Bypass, Cardiac Surgery.

Pulmonary Parameters in Adolescents with Severe Thoracic Idiopathic Scoliosis: Comparison Girls versus Boys.

The study compared pulmonary parameters, registered at the preoperative examination, in adolescent boys versus girls, both with severe thoracic idiopathic scoliosis. Thirty consecutive boys and 30 consecutive girls with Lenke 1 or 3 type, in the age range 14–18 years, with a Cobb angle of >50° and Risser sign ≥ 3 were enrolled. Corrected body height was used to calculate pulmonary parameters according to the Global Lung Function (GLI 2012) reference values. Significantly higher values of the calculated predicted pulmonary parameters and the upper and lower limit of normal (ULN and LLN), as well as significantly higher absolute values of forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1), were observed in boys than girls; however, the registered FVC and FEV1, expressed as percentages of the predicted values, tended to be lower in boys. The FEV1 z-score difference between boys and girls may suggest a need for more intensive preoperative pulmonary rehabilitation in boys.

Postoperative pulmonary complications following head and neck oncosurgery - Case control study

Head and neck cancers (HNC) constitute about one-third of all cancers in India. A combination of surgery, chemotherapy and radiotherapy is used to manage them. There is a high incidence of PPCs following head and neck surgeries. The probable mechanisms behind it are alteration in swallowing mechanisms and impairment in protective factors of the laryngeal apparatus.To study the association between the clinicodemographic and perioperative parameters and the occurrence of PPCs following head and neck oncosurgery. This case-control study was conducted in150 patients after head and neck oncosurgery. 50 patients as cases with complications and 100 patients as control with no complications were included in the study after getting informed consent and results were statistically analyzed and discussed. A pre-tested semi-structured case study form was used to collect patient information. Mean ages among cases and controls were 58.76 ± 10.40 and 56.10 ± 12.61. Weight loss was present in 26% of patients and 8% of controls. Malignancy of the tongue was the most common among both patients and controls, constituting 22% and 25%, respectively, followed by mouth and larynx. Preoperative albumin levels, presence of ARI within one month of surgery and lack of preoperative pulmonary rehabilitation had a significant association with the development of PPCs.From this study, we concluded correction of the modifiable preoperative risk factors might prove beneficial in reducing the incidence of PPCs.

Effects of enhanced recovery after surgery plus pulmonary rehabilitation on complications after video-assisted lung cancer surgery: a multicentre randomised controlled trial

BackgroundLung cancer surgery is associated with a high incidence of postoperative pulmonary complications (PPCs). We evaluated whether enhanced recovery after surgery plus pulmonary rehabilitation was superior over enhanced recovery after...

Rapid Recovery of Postoperative Pulmonary Function in Patients With Lung Cancer and Influencing Factors

Among malignant tumors, lung cancer has the highest morbidity and mortality worldwide. Surgery is the first-line treatment for early-stage lung cancers, and has gradually advanced from conventional open-chest surgery to video-assisted thoracic surgery (VATS). Additionally, increasingly smaller surgical incisions and less surgical trauma have resulted in reduced pulmonary function damage. Previous studies have found that the level of pulmonary function loss and recovery is significantly correlated with postoperative complications and the quality of life. Thus, an accurate assessment of the preoperative pulmonary function and effective rehabilitation of postoperative pulmonary function are highly important for patients undergoing lung surgery. In addition, pulmonary function assessment after pulmonary rehabilitation serves as an objective indicator of the postoperative pulmonary rehabilitation status and is crucial to facilitating pulmonary function recovery. Furthermore, a complete preoperative assessment and effective rehabilitation are especially critical in elderly patients with pulmonary tumors, poor basic physiological functions, comorbid lung diseases, and other underlying diseases. In this review, we summarize the clinical significance of pulmonary function assessment in patients undergoing lung cancer surgery, postoperative changes in pulmonary function, effective pulmonary function rehabilitation, and the influencing factors of pulmonary function rehabilitation.

비소세포폐암 환자에서의 수술 전후 호흡재활치료

Pulmonary rehabilitation (PR) a safe and feasible option for patients with non-small cell lung cancer (NSCLC) before and after lobectomy or pneumonectomy. Pulmonary function test and oxygen consumption should be evaluated in these patients before and after the PR sessions. For those who are not eligible for surgery due to poor physical performance may have the chance to to receive surgical treatment by improving their exercise capacity after preoperative PR sessions. At the same time, pre-operative PR reduces post-operative morbidity and mortality. Also, post-operative PR enhances functional regain after surgery, and reduces recovery time, post-operative complication, and hospital stays.

The effect of home-based preoperative pulmonary rehabilitation before lung resection: A retrospective cohort study

ObjectivesThis study aimed to assess the effect of home-based preoperative pulmonary rehabilitation (HBPPR) on the incidence of postoperative complications, length of stay (LOS), and duration of intercostal catheterization in non-small cell lung cancer (NSCLC) patients who underwent lung resection. Materials and methodsIn this retrospective cohort study, 144 patients who underwent lung resection were recruited, 51 of whom received HBPPR, comprising respiratory muscle training and was supervised (for patients undergoing it for the first time). Patients continued these programs for 2–4 weeks during the preoperative waiting period, in their homes. Data on postoperative complications graded according to the Clavien-Dindo classification, LOS, and intercostal catheterization duration were collected from medical records. These outcomes were compared between the HBPPR and non-HBPPR groups using Fisher’s exact test and Wilcoxon rank sum test, after 1:1 propensity score matching to avoid selection bias. ResultsForty-nine matched pairs were extracted using propensity score matching. HBPPR reduced the onset of postoperative complications (p = 0.04), with the relative ratio (RR) for Clavien-Dindo Class I postoperative complications showing a significant difference (RR 0.55, 95% CI 0.30-1.02; p = 0.05), whereas RRs for the other Clavien-Dindo classes were not statistically significant. There was no significant difference in LOS or the duration of intercostal catheterization. ConclusionHBPPR reduced the incidence of Clavien-Dindo Class I postoperative complications after lung resection. Implementing HBPPR practices in a clinical setting would benefit patients unable to receive supervised preoperative pulmonary rehabilitation due to access barriers, time, and financial constraints.

Pre-operative and Post-operative Pulmonary Rehabilitation

Pre-operative and Post-operative Pulmonary Rehabilitation

Lung transplantation for idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis (IPF) is characterized by relentlessly progressive lung function impairment that is consistently fatal in the absence of lung transplantation, as no curative pharmacological treatment exists. The pace of progression varies across patients, and acute life-threatening exacerbations occur unpredictably, causing further sharp drops in lung function. Recently introduced antifibrotic agents slow the pace of disease progression and may improve survival but fail to stop the fibrotic process. Moreover, the magnitude and kinetics of the response to these drugs cannot be predicted in the individual patient. These characteristics require that lung transplantation be considered early in the course of the disease. However, given the shortage of donor lungs, lung transplantation must be carefully targeted to those patients most likely to benefit. Current guidelines for lung transplantation listing may need reappraisal in the light of recent treatment advances. Patients with IPF often have multiple comorbidities such as coronary heart disease, frailty, and gastro-oesophageal reflux disease (GERD). Consequently, extensive screening for and effective treatment of concomitant conditions is crucial to appropriate candidate selection and outcome optimisation. A multidisciplinary approach is mandatory. Pulmonologists with expertise in IPF must work closely with lung transplant teams. Careful consideration must be given to preoperative optimisation, surgical technique, and pulmonary rehabilitation to produce the best post-transplantation outcomes.

Preoperative Evaluation for Lung Resection Surgery

The purpose of this article is to review the literature surrounding preoperative assessment and management of patients undergoing lung resection surgery. The traditional preoperative cardiovascular risk assessment can be further refined in patients undergoing lung resection surgery with the Thoracic Revised Cardiac Risk Index and cardiac biomarkers such as B-type natriuretic peptide. Cardiorespiratory exercise testing parameters such as the maximal achieved oxygen consumption (VO2 peak) and the minute ventilation to carbon dioxide output (VE/VCO2) slope are strong preoperative prognosticators in patients with borderline lung function. Preoperative pulmonary rehabilitation holds promising benefits in improving surgical candidacy and postoperative outcomes. The preoperative assessment of lung resection candidates must evaluate perioperative cardiorespiratory risk. The patient’s comorbidities should be optimized as time permits. A clear perioperative plan should be established and may include cardiology consultation, prevention strategies for arrhythmias, preoperative pulmonary rehabilitation, smoking cessation, intensive perioperative monitoring, and enhanced recovery protocols.

Findings of a feasibility study of pre-operative pulmonary rehabilitation to reduce post-operative pulmonary complications in people with chronic obstructive pulmonary disease scheduled for major abdominal surgery.

Background: Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of complications and death following surgery. Pulmonary complications are particularly prominent. Pulmonary rehabilitation is a course of physical exercise and education that helps people with COPD manage their condition. Although proven to improve health outcomes in patients with stable COPD, it has never been formally tested as a pre-surgical intervention in patients scheduled for non-cardiothoracic surgery. If a beneficial effect were to be demonstrated, pulmonary rehabilitation for pre-surgical patients with COPD might be rapidly implemented across the National Health Service, as pulmonary rehabilitation courses are already well established across much of the United Kingdom (UK). Methods: We performed a feasibility study to test study procedures and barriers to identification and recruitment to a randomised controlled trial testing whether pulmonary rehabilitation, delivered before major abdominal surgery in a population of people with COPD, would reduce the incidence of post-operative pulmonary complications. This study was run in two UK centres (Oxford and Newcastle upon Tyne). Results: We determined that a full randomised controlled trial would not be feasible, due to failure to identify and recruit participants. We identified an unmet need to identify more effectively patients with COPD earlier in the surgical pathway. Service evaluations suggested that barriers to identification and recruitment would likely be the same across other UK hospitals. Conclusions: Although pulmonary rehabilitation is a potentially beneficial intervention to prevent post-operative pulmonary complications, a randomised controlled trial is unlikely to recruit sufficient participants to answer our study question conclusively at the present time, when spirometry is not automatically conducted in all patients planned for surgery. As pulmonary rehabilitation is a recommended treatment for all people with COPD, alternative study methods combined with earlier identification of candidate patients in the surgical pathway should be considered. Trial registration: ISRCTN29696295, 31/08/2017.

Effectiveness of home-based preoperative pulmonary rehabilitation in COPD patients undergoing lung cancer resection.

To investigate the effectiveness of a home-based preoperative rehabilitation program for improving preoperative lung function and surgical outcome of patients with chronic obstructive pulmonary disease (COPD) undergoing lobectomy for cancer. This was a prospective, observational, single-center study including 59 patients with mild COPD who underwent lobectomy for lung cancer. All patients attended a home-based preoperative rehabilitation program including a minimum of 3 sessions each week for 4 weeks. Each session included aerobic and anaerobic exercises. Participants recorded the frequency and the duration of exercise performed in a diary. The primary end point was to evaluate changes in lung function including predicted postoperative (PPO) forced expiratory volume in 1 second (FEV1), 6-minute walking distance test (6MWD), PPO diffusing capacity for carbon monoxide (DLCO) %, and blood gas analysis values before and after the rehabilitation program. Postoperative pulmonary complications were recorded and multivariable analysis was used to identify independent prognostic factors (secondary end point). All patients completed the 4-week rehabilitation program. Thirteen of 59 (22%) patients (Group A) performed <3 sessions per week (mean sessions per week: 2.3±1.3); 46 of 59 (78%) patients (Group B) performed ⩾3 sessions per week (mean sessions per week: 3.5±1.6). The comparison of PPO FEV1% and 6MWD before and after rehabilitation showed a significant improvement only in Group B. No significant changes in PPO DLCO% or in blood gas analysis values were seen. Nine patients presented postoperative pulmonary complications, including atelectasis (n = 6), pneumonia (n = 1), respiratory failure (n = 1), and pulmonary embolism (n = 1). Group A presented higher number of postoperative pulmonary complications than Group B (6 vs 3; p = 0.0005). Multivariate analysis showed that the number of weekly rehabilitation sessions was the only independent predictive factor (p = 0.001). Our simple and low-cost rehabilitation program could improve preoperative clinical function in patients with mild to moderate COPD undergoing lobectomy and reduce postoperative pulmonary complications. All patients should be motivated to complete at least 3 rehabilitation sessions per week in order to obtain significant clinical benefits. Our preliminary results should be confirmed by larger prospective studies.

The effects of preoperative pulmonary rehabilitation on early postoperative period following lung transplantation

CONTEXT: Although pulmonary rehabilitation (PR) has become a preoperative standard practice, the fact that studies do not include groups of patients who do not receive preoperative PR restricts to introduce the real benefit of the rehabilitation process in lung transplantation (LTx). AIMS: We aimed to investigate the effect of preoperative PR before LTx on postoperative period. SETTINGS AND DESIGN: Retrospective, parallel design. SUBJECTS AND METHODS: Between March 2012 and October 2014, medical records of patients who underwent LTx were analyzed. There were two parallel groups. (1) Study group (n = 15) included the patients with received preoperative PR for at least 8 weeks. (2) Control group (n = 12) included the patients with underwent LTx without preoperative PR as appropriate donor was found. Time to intubation, length of intensive care unit (ICU) stay, and postoperative early mortality were evaluated. STATISTICAL ANALYSIS USED: Shapiro–Wilk, Fisher' exact test, Mann–Whitney U-test, Wilcoxon rank test. RESULTS: A total of 27 patients with LTx surgery, whose mean age was 40.6 (11.4) and 40% of females were included in the study. There were no significant differences in demographic characteristics between two groups, except the age (P = 0.005). The study group intubation time (2 [0–7] days) was shorter than control group (3 [1–12] days) (P = 0.02). There was no significant difference in the length of ICU stay postoperatively (P = 0.19) and postoperative early mortality rate (P = 0.65). CONCLUSIONS: Our study results suggest that preoperative PR may shorten time to intubation in patients undergoing LTx. Therefore, referral of LTx to PR centers and preoperative PR is of utmost importance for postoperative LTx.

A case study: Effectiveness of preoperative pulmonary rehabilitation program in liver transplantation patient

A 56-year-old male patient suffering from multiple conditions of decompensated chronic liver disease, alcohol-related cirrhosis of liver stage of CHILD-B, model for end-stage liver disease-11, and portal hypertension and admitted for liver transplantation in a specialty hospital was reported in this study. Previously, the patient was hospitalized for several times for hepatic encephalopathy. Preoperative evaluation was done by a pulmonologist for cardiorespiratory fitness. The patient was examined with high-resolution computed tomography chest and the functional capacity evaluation by 6-min walk test. The reports showed that the patient is not fit for surgery due to interstitial lung disorder, significant desaturation, noticeable dyspnea, and limited functional walk capacity, and hence, he was referred for cardiorespiratory fitness to the unit of pulmonary rehabilitation program for 12 weeks.

P2.16-42 The Use of a Smartphone Application Improves Postoperative Outcomes in Patients Undergoing Lung Cancer Resection

For early stages of lung cancer, complete surgical resection with curative intent for patients who are surgical candidates remains the most effective treatment. However, thoracic surgery procedures are related to postoperative pulmonary complications which increase the morbidity and mortality. Preoperative pulmonary rehabilitation programs improve postoperative outcomes. This study aims to evaluate the role of a smartphone application to improve pulmonary rehabilitation in a group patients scheduled for lung cancer resection. A Smartphone application containing peri-operative medical advice (stop smoking, mouth health, early mobilization and pain control) and ten chest physical exercises (aerobic exercise, inspiratory muscle strength and secretion mobilization technique) was created. This prospective and no randomized study was developed between January 2017 and December 2018. All patients scheduled for surgery were asked to participate. A group of 68 patients used and interacted with the software before and after the surgery. The control group (114 patients) received classical information and education by the Department of Physical Medicine and Rehabilitation. Clinical-pathological variables, incidence of postoperative pulmonary complications, duration of chest drainage, length of hospital stay and 30 days mortality rate were recorded and analyzed. Postoperative pulmonary complications were developed 17.6% in the intervention group and 33.3% in the control group (P=0.02). The length of hospital stay was shorter in the intervention group (median 3±4.09d vs. 5±6.87d P=0.001). No differences were found in duration of chest drainage or 30 day mortality compared with control group. This new technological resource created by thoracic surgeons demonstrates that preoperative rehabilitation program and patient education improve postoperative outcomes in patients undergoing lung cancer resection, decreasing the incidence of postoperative pulmonary complications and length of hospital stay.

The effectiveness of preoperative pulmonary rehabilitation in reducing postoperative pulmonary complications in lung cancer: a systematic review and meta-analysis

The effectiveness of preoperative pulmonary rehabilitation in reducing postoperative pulmonary complications in lung cancer: a systematic review and meta-analysis