Ultra-short-period perioperative pulmonary rehabilitation on short-term outcomes after surgery in smoking patients with lung cancer: a randomized clinical trial

Background:Pulmonary rehabilitation (PR) is essential for airway management after thoracic surgery. Most current PRs are composed of 2-4-week exercises, which require significant consumption of medical resources and concerns about disease progression. Materials and methods:This single-center, prospective, randomized controlled trial enrolled smoking patients with pulmonary masses or nodules suitable for lobectomy, aged 18-80, with a smoking history (>= 20 pack-years). Eligible patients were randomized in a 1:1 ratio into two groups. Patients in the intervention group underwent perioperative breathing exercises based on positive pressure vibration expectoration and 3-day preoperative lower limb endurance training. Patients in the control group received routine perioperative care. The primary outcome was in-hospital incidence of postoperative pulmonary complications. Secondary outcomes included postoperative hospital stay, total hospitalization cost, postoperative drainage time, drainage volume, semiquantitative cough strength score, pain score, Borg scale-assessed fatigue, and walking distance on postoperative days 1 and 2. Results:A total of 194 patients were included in the study, with 94 in the intervention group and 100 in the control group. Our ultrashort PR program potentially reduced pulmonary complications incidence (24.5 vs. 33.0%), but without statistical significance (P=0.190). No significant differences were found in other perioperative outcomes, except for postoperative semiquantitative cough strength score (3 [interquartile range, 3-3.75] vs. 3 [interquartile range, 2-3], P<0.001) and change in walking distance from postoperative days 1 to 2 (60 [interquartile range, 40-82.5] vs. 30 [interquartile range, 10-60], P=0.003). Conclusion:There were no significant differences in postoperative complications and other hospitalizations, but our ultrashort rehabilitation program improved patients' semiquantitative cough strength score and walking distance, indicating the potential for better outcomes. This treatment is a safe and effective means of airway management for thoracic surgery in the era of enhanced recovery (ClinicalTrials.gov Identifier: NCT03010033).