Impact of preoperative pulmonary rehabilitation on the Thoracoscore of patients undergoing lung resection

OBJECTIVES Patients with dyspnoea who are suitable for lung resection have a higher in-hospital mortality following surgery as predicted by the Thoracoscore. We evaluated the role of preoperative pulmonary rehabilitation (PPR) in improving preoperative dyspnoea, performance status and thereby the Thoracoscore and reducing the risk of postoperative mortality, complications and length of stay in such patients. METHODS From June 2013 until May 2014, we prospectively and sequentially identified high-risk patients in our outpatient clinic with dyspnoea grade ≥2 and performance status ≥1 for lung resection and recruited them for PPR. Thoracoscores, dyspnoea grade and performance status before and after PPR were calculated for all patients. Hospital mortality, complication rates and the length of hospital stay following surgery were compared between those who received PPR with those who did not undergo PPR and instead went straight to surgery. RESULTS Of the 42 patients (67% females, mean age 67 years [SD 13]) identified, 33 patients received PPR for a mean duration of 7.1 [SD 6.5] days. Their mean Thoracoscores before and after PPR were 6.4 [SD 5.1] and 1.7% [SD 1.3] (P < 0.00009); dyspnoea grade 3.8 [SD 0.6] and 2.2 [SD 0.6] (P < 0.00001); and performance status 2.7 [SD 0.5] and 1.7 [SD 0.6] (P < 0.00001), respectively. The postoperative mortality in those who received PPR and those who did not undergo PPR but went straight to surgery, respectively, was 0 vs 11.1% (P = 0.05), postoperative complication rate was 5.3 vs 37.5% (P < 0.015) and the mean length of hospital stay was 8.7 [SD 3.5] days vs 10.3 [SD 6.2] days (P = 0.26), respectively. CONCLUSIONS Our prospective study suggests that in those patients with dyspnoea requiring lung resection, PPR significantly improves their exercise capacity, reduces dyspnoea and improves the Thoracoscore. The study also suggests that PPR helps reduce postoperative complications and obviates the increased length of hospital stay and in-hospital mortality that may be otherwise expected.