Comprehensive Pulmonary Rehabilitation is an Effective Way for Better Postoperative Outcomes in Surgical Lung Cancer Patients with Risk Factors: A Propensity Score-Matched Retrospective Cohort Study

Figures & data

Table 1 Baseline and Clinical Characteristics Between Two Groups Before and After Propensity Score Matching

Characteristics	Full Cohort			Matched Cohort			Standardized Difference
	IG (n = 205)	CG (n = 2205)	P value	IG (n = 205)	CG (n = 820)	P value	Before	After
Age (yr)	60.13 ± 9.23	57.98 ± 10.06	0.003	60.13 ± 9.23	59.76 ± 9.74	0.623	0.217	0.013
BMI (kg/m^2)	23.54 ± 3.14	23.34 ± 3.01	0.363	23.54 ± 3.14	23.36 ± 2.98	0.451
FEV1 (L)	2.43 ± 0.61	2.55 ± 0.64	0.019	2.43 ± 0.61	2.45 ± 0.60	0.510	−0.165	0.001
FEV1%	96.97 ± 18.26	101.03 ± 18.82	0.003	96.97 ± 18.26	99.10 ± 19.82	0.141	−0.209	0.006
DLco%	93.84 ± 16.96	96.78 ± 17.21	0.019	93.84 ± 16.96	94.96 ± 18.58	0.431	−0.150	0.006
MVV%	97.83 ± 20.42	101.71 ± 20.78	0.010	97.83 ± 20.42	99.61 ± 22.00	0.293	−0.176	0.010
Gender (n, %)(n, %)			0.395			0.876
Male	109 (53.2%)	1104 (50.1%)		109 (53.2%)	430 (52.4%)		0.092	−0.002
Female	96 (46.8%)	1101 (49.9%)		96(46.8%)	390 (47.6%)		−0.092	0.002
Smoking status (n, %)			0.082			0.387
Current or former smokers	85 (41.5%)	780 (35.4%)		85 (41.5%)	313 (38.2%)
Non-smokers	120 (58.5%)	1425 (64.6%)		120 (58.5%)	507 (61.8%)
Comorbidities (n, %)
Diabetes mellitus	13 (6.3%)	158 (7.2%)	0.660	13 (6.3%)	47 (5.7%)	0.739
Hypertension	45 (22.0%)	458 (20.8%)	0.691	45 (22.0%)	176 (21.5%)	0.879
COPD	52 (25.4%)	412 (18.7%)	0.021	52 (25.4%)	194 (23.7%)	0.609	0.146	0.023
Surgical approach (n, %)			0.992			0.765
Open	48 (23.4%)	517 (23.4%)		48 (23.4%)	184 (22.4%)
VATS	157 (76.6%)	1688 (76.6%)		157 (76.6%)	636 (77.6%)
Operation time (min)	120.17 ± 29.99	121.95 ± 33.88	0.467	120.17 ± 29.99	120.48 ± 32.56	0.925
Intraoperative infusion (median, IQR, mL)	1000 (600–1200)	800 (600–1100)	0.098	1000 (600–1200)	900 (600–1100)	0.285	0.054	0.005
Blood loss (median, IQR, mL)	50 (20–100)	50 (20–100)	0.469	50 (20–100)	50 (20–100)	0.263
Histologic subtypes (n, %)			0.939			0.879
Adenocarcinoma	169 (82.4%)	1839 (83.4%)		169 (82.4%)	683 (83.3%)
Squamous carcinoma	28 (13.7%)	284 (12.9%)		28 (13.7%)	102 (12.4%)
Other NSCLC	8 (3.9%)	82 (3.7%)		8 (3.9%)	35 (4.3%)
Pathological stage (n, %)			0.748			0.575
Stage I	138 (67.3%)	1523 (69.1%)		138 (67.3%)	559 (68.1%)
Stage II	36 (17.5%)	367 (16.6%)		36 (17.5%)	126 (15.4%)
Stage III	27 (13.2%)	290 (13.2%)		27 (13.2%)	126 (15.4%)
Stage IV	4 (2.0%)	25 (1.1%)		4 (2.0%)	9 (1.1%)

Abbreviations: IG, intervention group; CG, control group; FEV1, forced expiratory volume in one second; Dlco, diffusion capacity for carbon monoxide; MVV, maximal voluntary ventilation; COPD, chronic obstructive pulmonary disease; VATS, video-assisted thoracoscopic surgery; NSCLC, non-small cell lung cancer.

Figure 1 Plot of the propensity score-matched study before and after matching. (A) Dot plot of standardized mean difference; (B) jitter plot of individual cases; (C) histogram of standardized mean differences.

Table 2 The Outcomes and Postoperative Pulmonary Complications Rate Between Two Groups Before and After Propensity Score Matching

Characteristics	Full Cohort			Matched Cohort
	IG (n = 205)	CG (n = 2205)	P value	IG (n = 205)	CG (n = 820)	P value
Duration of chest tube (median, IQR)	3 (2–4)	3 (2–5)	0.300	3 (2–4)	3 (2–4)	0.147
Length of stay (median, IQR, days)
Preoperative	7 (7–11)	7 (5–11)	0.071	7 (7–11)	7 (6–11)	0.565
Postoperative	5 (4–7)	6 (4–8)	< 0.001	5 (4–7)	7 (4–8)	< 0.001
Total	13 (10–18)	13 (10–17)	0.354	13 (10–18)	14 (11–18)	0.002
Hospitalization expenses (median, IQR, ¥)
Total	52,334 (48,312–58,726)	53,553 (46,538–56,332)	0.212	52,334 (48,312–58,726)	54,318 (47,387–59,543)	0.063
Rehabilitation expenses	983 (976–994)	0	< 0.001	983 (976–994)	0	< 0.001
Materials expenses	11,090 (9449–12,727)	10,905 (9092–13,210)	0.927	11,090 (9449–12,727)	11,137 (9144–13,963)	0.298
Bed expenses	540 (384–1022)	510 (352–960)	0.083	540 (384–1022)	538 (384–1118)	0.620
Nursing expenses,	211 (160–315)	224 (176–349)	0.117	211 (160–315)	232 (183–325)	0.086
Laboratory test expenses	2088 (1093–3750)	2012 (993–3539)	0.271	2088 (1093–3750)	2083 (1029–3654)	0.346
Operation expenses	5409 (4281–5409)	5409 (4281–6236)	0.196	5409 (4281–5409)	5285 (4281–6016)	0.552
Drug expenses	7146 (5411–8987)	7577 (5567–9880)	0.045	7146 (5411–8987)	8253 (6048–11,483)	< 0.001
PPCs rate (n, %)	55 (26.8%)	632 (28.7%)	0.578	55 (26.8%)	301 (36.7%)	0.008
Air leak > 5 d	28 (13.7%)	298 (13.5%)	0.954	28 (13.7%)	121 (14.8%)	0.758
Pneumonia	22 (10.7%)	240 (10.9%)	0.947	22 (10.7%)	137 (16.8%)	0.035
Atelectasis	18 (8.8%)	207 (9.4%)	0.775	18 (8.8%)	115 (14.0%)	0.046
Pulmonary embolism	1 (0.5%)	10 (0.4%)	0.577	1 (0.5%)	5 (0.6%)	1.000
ARDS	0 (0.0%)	7 (0.3%)	1.000	0 (0.0%)	5 (0.6%)	1.000
Ventilator support >48 h	0 (0.0%)	10 (0.5%)	1.000	0 (0.0%)	2 (0.2%)	1.000
Empyema	0 (0.0%)	7 (0.3%)	1.000	0 (0.0%)	5 (0.6%)	1.000
Bronchopleural fistula	0 (0.0%)	5 (0.2%)	1.000	0 (0.0%)	2 (0.2%)	1.000
Reintubation	4 (2.0%)	45 (2.0%)	0.861	4 (2.0%)	17 (2.1%)	0.780
Unexpected admission to ICU	0 (0.0%)	8 (0.4%)	1.000	0 (0.0%)	8 (0.4%)	1.000

Abbreviations: IG, intervention group; CG, control group; ARDS, adult respiratory distress syndrome.

Table 3 Clinical Characteristics Between PPCs Group and Non-PPCs Group After Propensity Score Matching

Characteristics	PPCs Group (n = 356)	Non-PPCs Group (n = 669)	P value
Age (yr)			< 0.001
<70	281 (78.9%)	589 (88.0%)
≥70	75 (21.1%)	80 (12.0%)
BMI (kg/m^2)	23.45 ± 3.17	23.39 ± 2.97	0.764
FEV1(L)	2.41 ± 0.65	2.47 ± 0.58	0.185
FEV1%			0.001
<70%	43 (12.1%)	42 (6.3%)
≥70%	313 (87.9%)	627 (93.7%)
DLco%			0.010
<70%	30 (8.5%)	30 (4.5%)
≥70%	326 (91.5%)	638 (95.5%)
MVV%			0.001
<70%	41 (11.5%)	38 (5.7%)
≥70%	315 (88.5%)	668 (94.3%)
CPR			0.008
Yes	55 (15.4%)	150 (22.4%)
No	301 (84.6%)	519 (77.6%)
Gender (n, %)			< 0.001
Male	233 (65.4%)	308 (46.0%)
Female	123 (34.6%)	361 (54.0%)
Smoking status (n, %)			< 0.001
Current or former smokers	179 (50.3%)	219 (32.7%)
Non-smokers	177 (49.7%)	450 (67.3%)
Comorbidities (n, %)
Diabetes mellitus	14 (5.9%)	46 (5.9%)	0.998
Hypertension	52 (21.8%)	169 (21.5%)	0.933
COPD	116 (32.6%)	130 (19.4%)	< 0.001
Surgical approach (n, %)			0.847
Open	53 (22.2%)	179 (22.8%)
VATS	186 (77.8%)	607 (77.2%)
Operation time (min)	121.88 ± 30.74	119.97 ± 32.44	0.420
Intraoperative infusion (median, IQR, mL)	900 (700–1300)	850 (600–1200)	0.126
Blood loss (median, IQR, mL)	60 (20–120)	50 (20–100)	0.088
Histologic subtypes (n, %)			0.871
Adenocarcinoma	293 (82.3%)	559 (83.6%)
Squamous carcinoma	47 (13.2%)	83 (12.4%)
Other NSCLC	16(4.5%)	27(4.0%)
Pathological stage (n, %)			0.450
Stage I	159(66.5%)	538(68.4%)
Stage II	42(17.6%)	120(15.3%)
Stage III	33(13.8%)	120(15.3%)
Stage IV	5(2.1%)	8(1.0%)

Abbreviations: FEV1, forced expiratory volume in one second; Dlco, diffusion capacity for carbon monoxide; MVV, maximal voluntary ventilation; CPR, comprehensive pulmonary rehabilitation; COPD, chronic obstructive pulmonary disease; VATS, video-assisted thoracoscopic surgery; NSCLC, non-small cell lung cancer.

Table 4 Multivariable Analysis of Risk to PPCs After Propensity Score Matching

Variables	OR	95% CI	P value
Age (ref = < 70 yr)	1.919	1.342–2.744	< 0.001
FEV1% (ref = > 70%)	1.149	0.614–2.150	0.665
DLco% (ref = > 70%)	1.579	0.910–2.740	0.104
MVV% (ref = > 70%)	1.390	0.831–2.326	0.210
CPR (ref = no)	0.655	0.430–0.865	0.006
Gender (ref = female)	1.328	0.914–1.929	0.136
Smoking history (ref = no)	2.048	1.552–2.704	< 0.001
COPD (ref = no)	1.580	1.160–2.152	0.004

Abbreviations: FEV1, forced expiratory volume in one second; Dlco, diffusion capacity for carbon monoxide; MVV, maximal voluntary ventilation; CPR, comprehensive pulmonary rehabilitation; COPD, chronic obstructive pulmonary disease.