Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, China; Department of Thoracic Surgery, Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou, China.
Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, China.
Ann Palliat Med. 2021 Apr;10(4):4418-4427. doi: 10.21037/apm-21-478. Epub 2021 Apr 19.
To evaluate the benefits of perioperative pulmonary rehabilitation training (PPRT) in patients undergoing thoracoscopic lung cancer resection.
The clinical data of 1,427 patients undergoing thoracoscopic lung cancer resection were collated. Of these patients, 779 received PPRT (the PPRT group), which included systematic education, improvement of posture, diaphragmatic respiration, bilateral lower thoracic expansion, surgical side thoracic local expansion, incentive spirometry training, effective cough training, aerobic walking, and other systematic pulmonary rehabilitation training. The other 648 patients did not receive PPRT (the non-PPRT group). Baseline characteristics including length of hospital stay, cost of hospitalization, and the incidence of postoperative pulmonary complications (PPCs) were assessed.
There was no significant difference between the PPRT group and the non- PPRT group in terms of age, gender distribution, tumor location, operation mode, postoperative pathological type, TNM stage, and other baseline characteristics (P>0.05). The complication index of the PPRT group was slightly higher than that of the non-PPRT group (P<0.05). Patients in the PPRT group had significantly fewer postoperative hospitalization days (PHD) {6.1 days [95% confidence interval (CI): 5.8 to 6.4] vs. 6.4 days (95% CI: 6.1 to 6.7), P=0.002}, fewer total hospitalization days (THD) [9.3 days (95% CI: 8.9 to 9.7) vs. 10.8 days (95% CI: 10.3 to 11.3), P=0.000], lower non-surgical expenses (35,024±9,742 vs. 36,831±10,245 RMB), and fewer cases of PPCs) (3.72% vs. 6.33%, P=0.016) compared to patients in the non-PPRT group. In the subgroup analysis, patients less than 60 years old in the PPRT group fared better in terms of the PHDs, total inpatient days, and non-surgical expenses compared to patients in the non-PPRT group (P<0.05). In patients aged 60 years and older, the THDs in the PPRT group was less than that in the non-PPRT group (P<0.05), but there were no significant differences in the PHDs and non-surgical expenses.
PPRT can reduce the cost of medical resources in patients undergoing thoracoscopic lung cancer resection, especially by shortening the length of hospital stay, reducing the cost of hospitalization, and reducing PPCs.
评估围手术期肺康复训练（PPRT）在接受胸腔镜肺癌切除术患者中的益处。
对 1427 例行胸腔镜肺癌切除术患者的临床资料进行了整理。其中 779 例接受了 PPRT（PPRT 组），包括系统教育、改善姿势、膈式呼吸、双侧下胸部扩张、手术侧胸局部扩张、激励式肺活量训练、有效咳嗽训练、有氧步行等系统肺康复训练。其他 648 例患者未接受 PPRT（非 PPRT 组）。评估了住院时间、住院费用和术后肺部并发症（PPCs）发生率等基线特征。
PPRT 组和非 PPRT 组在年龄、性别分布、肿瘤部位、手术方式、术后病理类型、TNM 分期等基线特征方面无显著差异（P>0.05）。PPRT 组并发症指数略高于非 PPRT 组（P<0.05）。PPRT 组患者术后住院日（PHD）明显减少[6.1 天（95%置信区间[CI]：5.8 至 6.4）比 6.4 天（95%CI：6.1 至 6.7），P=0.002]，总住院日（THD）明显减少[9.3 天（95%CI：8.9 至 9.7）比 10.8 天（95%CI：10.3 至 11.3），P=0.000]，非手术费用减少[35024±9742 比 36831±10245 元人民币]，且 PPCs 发生率较低（3.72%比 6.33%，P=0.016）。与非 PPRT 组相比，年龄小于 60 岁的 PPRT 组患者在 PHD、总住院日和非手术费用方面的情况更好（P<0.05）。而对于 60 岁及以上的患者，PPRT 组的 THD 短于非 PPRT 组（P<0.05），但 PHD 和非手术费用无显著差异。
PPRT 可降低胸腔镜肺癌切除术患者的医疗资源成本，特别是通过缩短住院时间、降低住院费用和减少 PPCs。
