The effectiveness of pre- and post-operative rehabilitation for lung cancer: A systematic review and meta-analysis on postoperative pulmonary complications and length of hospital stay

Abstract

Objective: To investigate the effects of rehabilitation either before or after operation for lung cancer on postoperative pulmonary complications and the length of hospital stay. Data sources: MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL Plus, SPORTDiscus, PsycInfo and Embase were searched from inception until June 2021. Review methods: Inclusion criteria were patients scheduled to undergo or had undergone operation for lung cancer, randomised controlled trials comparing rehabilitative interventions initiated before hospital discharge to usual care control. Two reviewers independently assessed eligibility, extracted data and risks of bias. Pooled odds ratios (ORs) or standardised mean differences (SMDs) with 95% Confidence Intervals (CI) were estimated using random-effects meta-analyses. Results: Twenty-three studies were included (12 preoperative, 10 postoperative and 1 perioperative), with 2068 participants. The pooled postoperative pulmonary complication risk and length of hospital stay were reduced after preoperative interventions (OR = 0.32; 95% CI = 0.22, 0.47; I2 = 0.0% and SMD = −1.68 days, 95% CI = −2.23, −1.13; I2 = 77.8%, respectively). Interventions delivered during the immediate postoperative period did not have any significant effects on either postoperative pulmonary complication or length of hospital stay (OR = 0.85; 95% CI = 0.56, 1.29; I2 = 0.0% and SMD = −0.23 days, 95% CI = −1.08, 0.63; I2 = 64.6%, respectively). Meta-regression showed an association between a higher number of supervised sessions and shorter hospital length of stay in preoperative studies (β = −0.17, 95% CI = −0.29, −0.05). Conclusion: Preoperative rehabilitation is effective in reducing postoperative pulmonary complications and length of hospital stay associated with lung cancer surgery. Short-term postoperative rehabilitation in inpatient settings is probably ineffective.

Application on perioperative ERAS concept in elderly lung cancer patients undergoing surgery

“…The preoperative respiratory function exercises aims to train patients' respiratory movements, improve their coughing efficiency, instruct them on postural drainage or other ways to promote sputum elimination, improve their respiratory efficiency, and reduce the accumulation of intrapulmonary secretions. [22,23] In addition, after surgery, ERAS-guided early activities, including turning, bedside activities, and the activities apart from the area of bed, those can lead to increased respiratory amplitude, enhanced effective gas exchange, easier discharge of secretions from the airways, reduced incisional infections, atelectasis, and the incidence of pleural effusion, promote the recruitment maneuver on lungs, and improve patients' pulmonary function. [24] Postoperative pain can lead to labored cough, restricted activity, emotional distress, and decreased immunity, and is a major factor affecting the recovery and postoperative hospital stay of patients with lung cancer.…”

Association of Preoperative Rehabilitation With Postoperative Length of Hospital Stay for Elderly Lung Cancer Patients

“…The strengths of our study were that it is the result of an analysis of 9,393 elderly lung cancer patients with real-world data and it was focused on LOS as the outcome. This reduction in LOS is meaningful because it leads to lower fees paid by patients and in- The effect of PR was assessed using the following: improved exercise capacity [12], pulmonary function [13], days with chest tubes [14], reduced postoperative complications [15], and shortened LOS [16,17]. One of the most common causes of delayed discharge from the hospital is the occurrence of postoperative pulmonary complications, such as pneumonia and atelectasis.…”

The efficacy of pulmonary rehabilitation exercise training on complications and mortality after lung cancer resection: a systematic review and meta-analysis

“…Additionally, Pu et al ( 18 ) reviewed the effects of preoperative respiratory movement on the postoperative outcomes of lung cancer patients undergoing radical pneumonectomy. Xu et al ( 20 ) examined the effects of preoperative and postoperative rehabilitation exercise training programs on postoperative pulmonary complications and hospital stay among lung cancer patients. The present study sought to update these findings using the data of the latest prospective studies to analyze the efficacy of lung rehabilitation exercise training programs on the postoperative complication and mortality rates of lung cancer patients.…”