Functional Recovery After Lung Resection: A Before and After Prospective Cohort Study of Activity

Background. Postoperative recovery is an important measure in thoracic operations. Personal activity monitors can be used to track progress in the preoperative and postoperative settings. This study investigates associations of preoperative activity, lung resection extent, and operative approach with inpatient and outpatient functional recovery as measured by activity monitors. Methods. In this prospective observational cohort study, patients undergoing lung resection at a single institution wore activity monitors 30 days before through 30 days after operation (between July 2015 and May 2017). Activity was recorded as steps per day, and each patient served as his or her own baseline. Patients were clustered into three activity level groups. Associations among preoperative and postoperative activity, length of stay (LOS), and operative approach were assessed by using generalized regression models with adjustment for patient demographic and clinical characteristics and operative details. Results. Sixty-six patients comprised the study cohort and were grouped by average preoperative activity: low, 21 patients (31.8%); moderate, 27 patients (40.9%); and high, 18 patients (27.3%). The mean age was 66.1 +/- 11.6 years; 32 patients (48.5%) were women. Sex, comorbidity, resection extent, and operative approach did not differ among groups. After adjustment for age, comorbidities, resection extent, operative approach, and complications, higher levels of preoperative activity were independently associated with higher postoperative activity in both inpatient and outpatient settings (beta = 1.11, 95% confidence interval [CI]: 1.00 to 1.22, p = 0.04; beta = 1.18, 95% CI: 1.07 to 1.30, p = 0.001) but not LOS. Conclusions. LOS is not associated with measures of preoperative or postoperative physical activity after adjustment for several factors. However, the association between preoperative activity and postoperative activity, irrespective of age, operative approach, resection extent, and other factors, offers a potential framework for designing recovery trajectory pathways and intervention development in both postoperative inpatient and outpatient settings. (C) 2019 by The Society of Thoracic Surgeons