The effect of multimodal prehabilitation on postoperative outcomes in lung cancer surgery

Objective: Patients with lung cancer are often elderly, frail, and smokers with poor functional reserve, making them excellent candidates for multimodal prehabilitation to improve postoperative outcomes. Patients referred to the prehabilitation clinic are at an even higher surgical risk. This retrospective observational study aimed to compare the postoperative 30-day outcomes in lung cancer surgery among the propensity score-matched patients. Methods: Patients who underwent lung cancer surgery between August 2018 and January 2024 were accessed for eligibility. After exclusion, a 1:1 propensity score-matching analysis was performed based on the following baseline characteristics: respiratory disease, predicted length of stay based on American College of Surgeons National Surgical Quality Improvement Program, Duke Activity Status Index less than 34, tumor stage, and neoadjuvant therapy. Baseline characteristics, preoperative and intraoperative data, and postoperative outcomes were compared between the matched patients. Results: Among 1242 patients, 555 were selected for propensity score matching, resulting in 147 matched pairs in each group. The control group exhibited significantly higher rates of overall (65.3% vs 46.3%, P = .001) and major complications (27.9% vs 13.6%, P = .003). Patients who underwent multimodal prehabilitation had a significantly lower Comprehensive Complication Index (12.2 [0-26.2] vs 0 [0-20.9], P < .0001), reduced intensive care unit admission rates (8.2% vs 2.7%, P = .040), and lower readmission rates (14.3% vs 6.1%, P = .021). Conclusions: Multimodal prehabilitation significantly reduced overall and major postoperative 30-day complications in lung cancer surgery. It also contributed to reducing the severity of complications. These findings suggest that multimodal prehabilitation may improve postoperative outcomes for patients with lung cancer. (J Thorac Cardiovasc Surg 2025;169:1631-44)