Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Perth, Australia.
Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Australia.
Interact Cardiovasc Thorac Surg. 2021 May 27;32(6):933-937. doi: 10.1093/icvts/ivab011.
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether preoperative physiotherapy (pulmonary prehabilitation) is beneficial for patients undergoing lung resection. Altogether 177 papers were found using the reported search, of which 10 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. A meta-analysis by Li et al. showed that patients who received a preoperative rehabilitation programme (PRP) had reduced incidence of postoperative pulmonary complications (PPCs) (odds ratio 0.44, 95% CI 0.27-0.71), reduced length of stay (LOS) (-4.23 days, 95% CI -6.14 to -2.32 days) and improved 6-min walking distance (71.25 m, 95% CI 39.68-102.82) and peak oxygen uptake consumption (VO2 peak) (3.26, 95% CI 2.17-4.35). A meta-analysis by Steffens et al. showed that PPCs were reduced in patients with PRP (relative risk 0.49, 95% CI 0.33-0.73) and reduced LOS (-2.86 days, 95% CI -5.40 to -0.33). The results of 3 additional meta-analyses, 4 randomized controlled trials and 1 observational study all provide further support to PRP in enhanced recovery after surgery and the improvement in exercise capacity. We conclude that PRP improves exercise capacity in patients undergoing surgical resection for lung cancer. Moderate quality evidence supports preoperative exercise providing significant reduction in PPCs and hospital LOS. Referral to exercise programmes should be considered in patients awaiting lung resection, particularly those deemed borderline for suitability for surgical resection.
一项胸外科最佳证据主题是根据结构化方案撰写的。提出的问题是术前物理治疗（肺康复）是否有益于接受肺切除术的患者。共使用报道的搜索方法找到了 177 篇论文，其中 10 篇代表了回答临床问题的最佳证据。作者、期刊、日期和出版国家、研究的患者群体、研究类型、这些论文的相关结果都列在表中。Li 等人的一项荟萃分析显示，接受术前康复计划（PRP）的患者术后肺部并发症（PPCs）的发生率降低（优势比 0.44，95%CI 0.27-0.71），住院时间（ LOS ）缩短（-4.23 天，95%CI-6.14 至-2.32 天），6 分钟步行距离（71.25 米，95%CI 39.68-102.82）和峰值摄氧量消耗（VO2 峰值）（3.26，95%CI 2.17-4.35）提高。Steffens 等人的一项荟萃分析显示，PRP 可降低 PPCs 的发生率（相对风险 0.49，95%CI 0.33-0.73）和 LOS （-2.86 天，95%CI-5.40 至-0.33）。另外 3 项荟萃分析、4 项随机对照试验和 1 项观察性研究的结果都进一步支持 PRP 在手术后快速康复和改善运动能力方面的作用。我们得出结论，PRP 可改善接受肺癌切除术的患者的运动能力。中等质量证据支持术前运动可显著降低 PPCs 和住院 LOS。应考虑向等待肺切除术的患者推荐运动计划，特别是那些被认为勉强适合手术切除的患者。
