Lai Yutian, Dong Yingxian, Tian Long, Li Hongjun, Ye Xinyi, Che Guowei
Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
Ann Surg Oncol. 2025 Jan;32(1):265-273. doi: 10.1245/s10434-024-16054-6. Epub 2024 Sep 19.
The aim of this study was to investigate the influence of the time of pre-rehabilitation (PR) combined with respiratory training and aerobic exercise on surgical patients with lung cancer.
A retrospective study from a 5-year database of a single center, including patients with lung cancer who underwent surgery between 1 January 2016 and 31 December 2020, was conducted. The patients were divided into the PR group, in which they received the PR regimen, and the non-PR group, in which they received routine care.
A total of 4452 patients were retrospectively included, 684 of whom received PR regimen. A lower postoperative pulmonary complication (PPC) rate was observed in PR group than in non-PR group before or after propensity score matching (PSM) (before: 12.6% vs 18.5%, P < 0.001; after: 12.6% vs 18.7%, P < 0.001). For the PR group, a restricted cubic spline model revealed a significant nonlinear dose‒response association between PR time and the occurrence of PPCs (P for nonlinearity = 0.002). The PR time associated with the lowest occurrence of PPCs was 7 days, and the odds ratio (OR) of PPCs decreased steeply, with an OR of 0.8 [95% confidence interval (CI) 0.66-0.97] per day until 7 days, and then remained stable with a slight increase afterward with an OR of 1.11 (95% CI 0.99-1.25) per day.
The study validated the effectiveness of a pre-rehabilitation regimen for decreasing the occurrence of PPCs. A U-shaped nonlinear relationship was found between pre-rehabilitation time and the PPC rate, indicating that both excessive and insufficient pre-rehabilitation time may increase the incidence of PPCs. Registry Number: ChiCTR1800020097.
本研究旨在探讨术前康复（PR）联合呼吸训练和有氧运动的时间对肺癌手术患者的影响。
对一个单中心5年数据库进行回顾性研究，纳入2016年1月1日至2020年12月31日期间接受手术的肺癌患者。患者分为接受PR方案的PR组和接受常规护理的非PR组。
共回顾性纳入4452例患者，其中684例接受了PR方案。倾向得分匹配（PSM）前后，PR组术后肺部并发症（PPC）发生率均低于非PR组（术前：12.6%对18.5%，P<0.001；术后：12.6%对18.7%，P<0.001）。对于PR组，受限立方样条模型显示PR时间与PPC发生之间存在显著的非线性剂量反应关联（非线性P=0.002）。与PPC发生率最低相关的PR时间为7天，PPC的优势比（OR）急剧下降，至7天时每天OR为0.8[95%置信区间（CI）0.66 - 0.97]，之后保持稳定并略有上升，每天OR为1.11（95%CI 0.99 - 1.25）。
本研究验证了术前康复方案对降低PPC发生率的有效性。术前康复时间与PPC发生率之间呈U形非线性关系，表明术前康复时间过长或过短均可能增加PPC的发生率。注册号：ChiCTR1800020097。
