Zhou Kun, Lai Yutian, Wang Yan, Sun Xin, Mo Chunmei, Wang Jiao, Wu Yanming, Li Jue, Chang Shuai, Che Guowei
Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China.
Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, People's Republic of China.
Cancer Manag Res. 2020 Sep 23;12:8903-8912. doi: 10.2147/CMAR.S267322. eCollection 2020.
To investigate the effectiveness and cost minimization of comprehensive pulmonary rehabilitation (CPR) in lung cancer patients who underwent surgery.
A retrospective observational study based on medical records was conducted, with 2410 lung cancer patients who underwent an operation with/without CPR during the peri-operative period. Variables including clinical characteristics, length of stay (LOS), postoperative pulmonary complications (PPCs), and hospitalization expenses were compared between the intervention group (IG) and control group (CG). The CPR regimen consists of inspiratory muscle training (IMT), aerobic endurance training, and pharmacotherapy.
Propensity score matching analysis was performed between two groups, and the ratio of matched patients was 1:4. Finally, 205 cases of IG and 820 cases of CG in the matched cohort of our study were identified. The length of postoperative hospital stay [median: 5 interquartile (4-7) vs 7 (4-8) days, < 0.001] and drug expenses [7146 (5411-8987) vs 8253 (6048-11,483) ¥, < 0.001] in the IG were lower compared with the CG. Additionally, the overall incidence of PPCs in the IG was reduced compared with the CG (26.8% vs 36.7%, = 0.008), including pneumonia (10.7% vs 16.8%, = 0.035) and atelectasis (8.8% vs 14.0%, = 0.046). Multivariable analysis showed that CPR intervention (OR = 0.655, 95% CI: 0.430-0.865, = 0.006), age ≥70 yr (OR = 1.919, 95% CI: 1.342-2.744, < 0.001), smoking (OR = 2.048, 95% CI: 1.552-2.704, < 0.001) and COPD (OR = 1.158, 95% CI: 1.160-2.152, = 0.004) were related to PPCs.
The retrospective cohort study revealed a lower PPC rate and the shorter postoperative length of stay in the patients receiving CPR, demonstrating the clinical value of CRP as an effective strategy for surgical lung cancer patients with risk factors.
探讨综合肺康复（CPR）对接受手术的肺癌患者的有效性及成本最小化情况。
进行一项基于病历的回顾性观察研究，纳入2410例在围手术期接受或未接受CPR的肺癌手术患者。比较干预组（IG）和对照组（CG）的临床特征、住院时间（LOS）、术后肺部并发症（PPCs）及住院费用等变量。CPR方案包括吸气肌训练（IMT）、有氧耐力训练和药物治疗。
两组间进行倾向得分匹配分析，匹配患者比例为1:4。最终，在本研究的匹配队列中确定了205例IG患者和820例CG患者。IG组的术后住院时间[中位数：5天（四分位间距4 - 7天）对7天（四分位间距4 - 8天），P < 0.001]和药物费用[7146元（5411 - 8987元）对8253元（6048 - 11483元），P < 0.001]低于CG组。此外，IG组的PPCs总体发生率较CG组降低（26.8%对36.7%，P = 0.008），包括肺炎（10.7%对16.8%，P = 0.035）和肺不张（8.8%对14.0%，P = 0.046）。多变量分析显示，CPR干预（OR = 0.655，95%置信区间：0.430 - 0.865，P = 0.006）、年龄≥70岁（OR = 1.919，95%置信区间：1.342 - 2.744，P < 0.001）、吸烟（OR = 2.048, 95%置信区间：1.552 - 2.704，P < 0.001）和慢性阻塞性肺疾病（COPD）（OR = 1.158，95%置信区间：1.160 - 2.152，P = 0.004）与PPCs相关。
回顾性队列研究显示，接受CPR的患者PPCs发生率较低且术后住院时间较短，表明CRP作为一种针对有危险因素的肺癌手术患者的有效策略具有临床价值。
