Effectiveness of perioperative pulmonary rehabilitation in thoracic surgery

Background: Functional condition is crucial for operability of patients with lung cancer and/or chronic respiratory diseases. The aim of the study was to measure changes of functional and quality of life parameters in terms of the effectiveness of perioperative pulmonary rehabilitation (PR). Methods: A total of 208 COPD patients (age: 63 +/- 9 years, man/woman: 114/94, FEV1: 62 +/- 14 % pred) participated in a perioperative PR program. The indication was primary lung cancer in 72% of the patients. The 68 patients participated in preoperative (PRE) rehabilitation, 72 in a pre- and postoperative rehabilitation (PPO) and 68 patients only in postoperative rehabilitation (POS). PR program included respiratory training techniques, individualized training and smoking cessation. Lung function tests, 6 minutes walking distance (6MWD) were measured before and after the rehabilitation. Quality of life tests [COPD Assessment Test (CAT) and Modified Medical Research Council Dyspnoea Scale (mMRC)] were evaluated as well. Results: There was a significant improvement in FEV1 (PRE: 64 +/- 16 vs. 67 +/- 16 % pred; PPO: 60 +/- 13 vs. 66 +/- 13 % pred before the operation, 48 +/- 13 vs. 52 +/- 13 % pred after the operation; POS: 56 +/- 16 vs. 61 +/- 14 % pred, P<0.05) and 6MWD (PRE: 403 +/- 87 vs. 452 +/- 86 m; PPO: 388 +/- 86 vs. 439 +/- 83 m before, 337 +/- 111 vs. 397 +/- 105 m after the operation; POS: 362 +/- 89 vs. 434 +/- 94 m, P<0.0001). Significant improvement was detected in FVC, grip strength, mMRC and CAT questionnaires as an effectiveness of PR, also. Average intensive care duration was 3.8 +/- 5.2 days with vs. 3.1 +/- 3.6 without preoperative PR. Conclusions: Improvements in exercise capacity and quality of life were seen following PR both before and after thoracic surgery.