1Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
2Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
3Department of Pathology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
4Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
Copyright © 2022 by the Korean Cancer Association
This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Ethical Statement
This study was approved by the Institutional Review Board of Korea University Guro Hospital (approval no. 2017GR0037). Owing to the retrospective nature of this study and the low risk to the patients, the institutional review committee waived the need for signed informed consent forms.
Author Contributions
Conceived and designed the analysis: Choi J, Yong HS, Lee SY.
Collected the data: Choi J, Yang Z, Lee J, Lee JH, Kim HK.
Contributed data or analysis tools: Choi J, Yang Z.
Performed the analysis: Choi J, Yang Z.
Wrote the paper: Choi J
Interpretation and review and comment: Choi J, Yong HS, Lee SY.
Conficts of Interest
Confict of interest relevant to this article was not reported.
Values are presented as mean±SD or number (%). COPD, chronic obstructive pulmonary disease; d, standardized mean difference; ICS, inhaled corticosteroids; IPF, idiopathic pulmonary fibrosis; LABA, long acting B agonist bronchodilator; LAMA, long acting antimuscarinic agent bronchodilator; SD, standard deviation.
Values are presented as mean±standard deviation. Δ, differences before and after surgery; HU, Hounsfield unit; HUESMcsa, Hounsfield unit of average intensity value of erector spinae muscle in cross-sectional area in computed tomography.
HUESMcsa (%)=Postoperation HUESMcsa–Preoperation HUESMcsa/Preoperation HUESMcsa×100.
Before matching | After matching | |||||
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Rehabilitation group (n=75) | Non-rehabilitation group (n=250) | p-value | Rehabilitation group (n=45) | Non-rehabilitation group (n=45) | p-value | |
Totala) | 10 (13.3) | 50 (20.0) | 0.192 | 4 (8.9) | 12 (26.7) | 0.027 |
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When two or more different events occur | 0 | 2 (0.8) | > 0.99 | 0 | 0 | > 0.99 |
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Major cardiovascular events or arrhythmia | 0 | 5 (2.0) | 0.593 | 0 | 1 (2.2) | > 0.99 |
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Pneumonia | 3 (4.0) | 6 (2.4) | 0.436 | 0 | 1 (2.2) | > 0.99 |
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Pneumothorax | 3 (4.0) | 9 (3.6) | > 0.99 | 1 (2.2) | 1 (2.2) | > 0.99 |
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Chest pain or dyspnea | 1 (1.3) | 8 (3.2) | 0.690 | 1 (2.2) | 0 | > 0.99 |
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Pulmonary embolism or deep vein thrombosis | 3 (4.0) | 19 (7.6) | 0.276 | 2 (4.4) | 8 (17.8) | 0.044 |
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Pleural effusion | 0 | 2 (0.8) | > 0.99 | 0 | 0 | > 0.99 |
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Etc.b) | 0 | 3 (1.2) | > 0.99 | 0 | 1 (2.2) | > 0.99 |
Baseline characteristics in the rehabilitation and non-rehabilitation groups before and after propensity score matching
Characteristic | Before matching | After matching | ||||||
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Rehabilitation group (n=75) | Non-rehabilitation group (n=250) | p-value | d | Rehabilitation group (n=45) | Non-rehabilitation group (n=45) | p-value | d | |
Age (yr) | 69.8±7.0 | 64.6±9.2 | < 0.001 | Infinity | 70.0±6.8 | 69.5±6.9 | 0.713 | 0.0730 |
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Sex | ||||||||
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Male | 59 (78.7) | 137 (54.8) | < 0.001 | Infinity | 30 (66.7) | 34 (75.6) | 0.352 | 0.2400 |
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Female | 16 (21.3) | 113 (45.2) | 15 (33.3) | 11 (24.4) | ||||
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Height (cm) | 163.5±7.7 | 161.8±8.5 | 0.116 | 0.2042 | 162.7±8.3 | 163.3±7.7 | 0.709 | 0.0749 |
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Weight (kg) | 64.8±10.2 | 63.0±8.5 | 0.203 | 0.2018 | 63.7±11.3 | 64.9±12.4 | 0.634 | 0.1012 |
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Smoking status | ||||||||
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Current smoker | 5 (6.7) | 23 (9.2) | 0.618 | 0.1294 | 4 (8.9) | 5 (11.1) | 0.621 | 0.2032 |
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Ex-smoker | 23 (30.7) | 85 (34.0) | 17 (37.8) | 21 (46.7) | ||||
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Non-smoker | 47 (62.7) | 142 (56.8) | 24 (53.3) | 19 (42.2) | ||||
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Comorbidities | ||||||||
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COPD | 19 (25.3) | 71 (28.4) | 0.603 | 0.0861 | 17 (37.8) | 21 (46.7) | 0.393 | 0.2015 |
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Asthma | 1 (1.3) | 8 (3.2) | 0.690 | 0.4932 | 1 (2.2) | 2 (4.4) | > 0.99 | 0.3948 |
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IPF | 1 (1.3) | 6 (2.4) | > 0.99 | 0.3301 | 1 (2.2) | 2 (4.4) | > 0.99 | 0.3948 |
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Hypertension | 39 (52.0) | 129 (51.6) | 0.952 | 0.0088 | 26 (57.8) | 25 (55.6) | 0.832 | 0.0499 |
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Diabetes | 17 (22.7) | 59 (23.6) | 0.867 | 0.0289 | 10 (22.2) | 8 (17.8) | 0.598 | 0.1537 |
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Coronary artery disease | 13 (17.3) | 38 (15.2) | 0.656 | 0.0865 | 8 (17.8) | 13 (28.9) | 0.213 | 0.3477 |
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Cerebrovascular accident | 4 (5.3) | 21 (8.4) | 0.382 | 0.2686 | 5 (11.1) | 5 (11.1) | > 0.99 | 0.0000 |
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Inhaler use | ||||||||
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LAMA | 1 (1.3) | 2 (0.8) | < 0.001 | 0.5769 | 1 (2.2) | 0 | 0.795 | 0.0343 |
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LABA+LAMA | 19 (25.3) | 25 (10.0) | 10 (22.2) | 9 (20.0) | ||||
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ICS+LABA | 6 (8.0) | 5 (2.0) | 2 (4.4) | 4 (8.9) | ||||
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Triple therapy | 2 (2.7) | 1 (0.4) | 0 | 1 (2.2) | ||||
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None | 47 (62.7) | 217 (86.8) | 32 (71.1) | 31 (68.9) | ||||
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Cancer-related treatment | ||||||||
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Neoadjuvant chemotherapy | 5 (6.7) | 12 (4.8) | 0.556 | 0.1920 | 3 (6.7) | 4 (8.9) | > 0.99 | 0.1719 |
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Neoadjuvant concurrent chemoradiotherapy | 7 (9.3) | 6 (2.4) | 0.014 | 0.7894 | 2 (4.4) | 2 (4.4) | > 0.99 | 0.0000 |
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Type of surgery | ||||||||
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Lobectomy | 39 (52.0) | 177 (70.8) | 0.006 | 0.3175 | 30 (66.7) | 31 (68.9) | > 0.99 | 0.0000 |
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Segmentectomy | 13 (17.3) | 33 (13.2) | 5 (11.1) | 5 (11.1) | ||||
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Wedge resection | 4 (5.3) | 5 (2.0) | 1 (2.2) | 0 | ||||
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Bilobectomy | 5 (6.7) | 3 (1.2) | 3 (6.7) | 2 (4.4) | ||||
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Lobectomy and segmentectomy | 4 (5.3) | 5 (2.0) | 1 (2.2) | 1 (2.2) | ||||
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Lobectomy and wedge resection | 10 (13.3) | 27 (10.8) | 5 (11.1) | 6 (13.3) | ||||
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Operation site | ||||||||
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Right upper lobe | 16 (21.3) | 62 (24.8) | 0.154 | 0.2261 | 12 (26.7) | 8 (17.8) | 0.882 | 0.1138 |
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Right middle lobe | 1 (1.3) | 15 (6.0) | 1 (2.2) | 1 (2.2) | ||||
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Right lower lobe | 15 (20.0) | 43 (17.2) | 7 (15.6) | 11 (24.4) | ||||
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Left upper lobe | 14 (18.7) | 61 (24.4) | 10 (22.2) | 9 (20.0) | ||||
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Left lower lobe | 10 (13.3) | 34 (13.6) | 6 (13.3) | 7 (15.6) | ||||
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Two or more lobes | 19 (25.3) | 35 (14.0) | 9 (20.0) | 9 (20.0) |
Values are presented as mean±SD or number (%). COPD, chronic obstructive pulmonary disease; d, standardized mean difference; ICS, inhaled corticosteroids; IPF, idiopathic pulmonary fibrosis; LABA, long acting B agonist bronchodilator; LAMA, long acting antimuscarinic agent bronchodilator; SD, standard deviation.
Preoperative pulmonary function test data before and after propensity score matching
Pulmonary function test parameter (before surgery) | Before matching | After matching | ||||||
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Rehabilitation group (n=75) | Non-rehabilitation group (n=250) | p-value | d | Rehabilitation group (n=45) | Non-rehabilitation group (n=45) | p-value | d | |
ΔFEV1 (L) | 2.2±0.6 | 2.5±0.6 | < 0.001 | Infinity | 2.3±0.6 | 2.4±0.5 | 0.310 | 0.1811 |
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ΔFEV1 (%) | 78.9±15.0 | 91.7±13.6 | < 0.001 | Infinity | 83.9±14.6 | 86.3±13.5 | 0.431 | 0.1707 |
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ΔFVC (L) | 3.4±0.9 | 3.5±0.8 | 0.334 | 0.1214 | 3.4±0.9 | 3.5±0.8 | 0.322 | 0.1174 |
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ΔFVC (%) | 85.4±14.4 | 93.3±11.8 | < 0.001 | Infinity | 88.0±14.6 | 90.6±11.4 | 0.350 | 0.1985 |
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FEV1/FVC | 65.6±10.9 | 73.2±8.7 | < 0.001 | Infinity | 68.1±9.7 | 67.8±8.4 | 0.853 | 0.0331 |
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DLCO (L) | 14.3±3.3 | 16.9±3.9 | < 0.001 | Infinity | 14.8±3.1 | 15.6±3.9 | 0.290 | 0.2271 |
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DLCO (%) | 75.7±14.8 | 87.3±14.9 | < 0.001 | Infinity | 79.8±13.6 | 81.9±15.3 | 0.482 | 0.1451 |
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DLCO/VA (L) | 3.2±0.8 | 3.7±0.7 | < 0.001 | Infinity | 3.4±0.8 | 3.3±0.7 | 0.728 | 0.1330 |
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DLCO/VA (%) | 85.2±18.1 | 93.4±15.8 | < 0.001 | Infinity | 88.4±18.0 | 87.3±16.9 | 0.773 | 0.0630 |
Values are presented as mean±SD. d, standardized mean difference; DLCO, carbon monoxide diffusing capacity; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; VA, alveolar volume.
Differences in postoperative lung function before and after propensity score matching
Pulmonary function test parameter | Before matching | After matching | ||||
---|---|---|---|---|---|---|
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| |||||
Rehabilitation group (n=75) | Non-rehabilitation group (n=250) | p-value | Rehabilitation group (n=45) | Non-rehabilitation group (n=45) | p-value | |
ΔFEV1 (L) | −0.3±0.3 | −0.5±0.3 | < 0.001 | −0.3±0.3 | −0.5±0.3 | 0.001 |
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ΔFEV1 (%) | −10.5±9.0 | −19.0±10.9 | < 0.001 | −11.6±9.3 | −18.8±11.0 | 0.001 |
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ΔFVC (L) | −0.5±0.4 | −0.7±0.5 | 0.006 | −0.6±0.4 | −0.8±0.5 | 0.019 |
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ΔFVC (%) | −13.8±9.5 | −18.9±11.3 | < 0.001 | −14.4±9.8 | −20.7±12.7 | 0.010 |
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ΔDLCO (L) | −1.9±2.4 | −2.7±2.6 | 0.021 | −1.9±2.4 | −2.4±3.3 | 0.385 |
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ΔDLCO (%) | −10.2±12.0 | −14.0±13.3 | 0.029 | −10.4±12.0 | −13.2±16.1 | 0.364 |
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ΔDLCO/VA (L) | 0.0±0.5 | 0.1±0.5 | 0.572 | 0.0±0.4 | 0.2±0.6 | 0.193 |
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ΔDLCO/VA (%) | 1.0±11.9 | 1.8±12.7 | 0.617 | 1.0±9.9 | 4.3±14.6 | 0.210 |
Values are presented as mean±SD. Δ, differences before and after surgery; DLCO, carbon monoxide diffusing capacity; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; VA, alveolar volume.
HUESMcsa measurement using computed tomography images
Before matching | After matching | |||||
---|---|---|---|---|---|---|
|
| |||||
Rehabilitation group (n=75) | Non-rehabilitation group (n=250) | p-value | Rehabilitation group (n=45) | Non-rehabilitation group (n=45) | p-value | |
Before surgery (cm2) | 3,717.6±823.0 | 3,712.3±970.0 | 0.966 | 3,580.4±829.0 | 3,787.9±1271.9 | 0.362 |
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Δ HUESMcsa | −15.6±166.5 | −159.6±199.0 | < 0.001 | −22.6±152.8 | −136.4±172.7 | 0.001 |
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Δ HUESMcsa (%) | −0.4±4.6 | −4.0±5.2 | < 0.001 | −0.6±4.4 | −3.4±4.1 | 0.003 |
Values are presented as mean±standard deviation. Δ, differences before and after surgery; HU, Hounsfield unit; HUESMcsa, Hounsfield unit of average intensity value of erector spinae muscle in cross-sectional area in computed tomography.
HUESMcsa (%)=Postoperation HUESMcsa–Preoperation HUESMcsa/Preoperation HUESMcsa×100.
Clinical outcomes related to surgery
Before matching | After matching | |||||
---|---|---|---|---|---|---|
|
| |||||
Rehabilitation group (n=75) | Non-rehabilitation group (n=250) | p-value | Rehabilitation group (n=45) | Non-rehabilitation group (n=45) | p-value | |
Period from admission to discharge (day) | 10.1±6.0 | 8.4±4.3 | 0.029 | 9.3±6.2 | 9.4±5.0 | 0.926 |
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HFNC application | 68 (90.7) | 219 (87.6) | 0.469 | 41 (91.1) | 35 (77.8) | 0.081 |
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Duration of HFNC use | 3.2±1.8 | 2.9±1.6 | 0.171 | 3.4±2.0 | 3.4±1.8 | 0.982 |
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90-Day mortality | 0 | 1 (0.4) | > 0.99 | 0 | 0 | > 0.99 |
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180-Day mortality | 2 (2.7) | 3 (1.2) | 0.326 | 2 (4.4) | 1 (2.2) | > 0.99 |
Values are presented as mean±SD or number (%). HFNC, high-flow nasal cannula.
Major postoperative complications (occurrence within 1 month)
Before matching | After matching | |||||
---|---|---|---|---|---|---|
|
| |||||
Rehabilitation group (n=75) | Non-rehabilitation group (n=250) | p-value | Rehabilitation group (n=45) | Non-rehabilitation group (n=45) | p-value | |
Total |
10 (13.3) | 50 (20.0) | 0.192 | 4 (8.9) | 12 (26.7) | 0.027 |
| ||||||
When two or more different events occur | 0 | 2 (0.8) | > 0.99 | 0 | 0 | > 0.99 |
| ||||||
Major cardiovascular events or arrhythmia | 0 | 5 (2.0) | 0.593 | 0 | 1 (2.2) | > 0.99 |
| ||||||
Pneumonia | 3 (4.0) | 6 (2.4) | 0.436 | 0 | 1 (2.2) | > 0.99 |
| ||||||
Pneumothorax | 3 (4.0) | 9 (3.6) | > 0.99 | 1 (2.2) | 1 (2.2) | > 0.99 |
| ||||||
Chest pain or dyspnea | 1 (1.3) | 8 (3.2) | 0.690 | 1 (2.2) | 0 | > 0.99 |
| ||||||
Pulmonary embolism or deep vein thrombosis | 3 (4.0) | 19 (7.6) | 0.276 | 2 (4.4) | 8 (17.8) | 0.044 |
| ||||||
Pleural effusion | 0 | 2 (0.8) | > 0.99 | 0 | 0 | > 0.99 |
| ||||||
Etc. |
0 | 3 (1.2) | > 0.99 | 0 | 1 (2.2) | > 0.99 |
Values are presented as number (%).
a)All cases where ‘hospitalization’ or ‘visit the emergency room’ or ‘intervention (procedure or anticoagulation) was added’ within one month for the reasons listed in the table,
b)Etc. contains dizziness or general weakness.
Values are presented as mean±SD or number (%). COPD, chronic obstructive pulmonary disease; d, standardized mean difference; ICS, inhaled corticosteroids; IPF, idiopathic pulmonary fibrosis; LABA, long acting B agonist bronchodilator; LAMA, long acting antimuscarinic agent bronchodilator; SD, standard deviation.
Values are presented as mean±SD. d, standardized mean difference; DLCO, carbon monoxide diffusing capacity; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; VA, alveolar volume.
Values are presented as mean±SD. Δ, differences before and after surgery; DLCO, carbon monoxide diffusing capacity; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; VA, alveolar volume.
Values are presented as mean±standard deviation. Δ, differences before and after surgery; HU, Hounsfield unit; HUESMcsa, Hounsfield unit of average intensity value of erector spinae muscle in cross-sectional area in computed tomography. HUESMcsa (%)=Postoperation HUESMcsa–Preoperation HUESMcsa/Preoperation HUESMcsa×100.
Values are presented as mean±SD or number (%). HFNC, high-flow nasal cannula.
Values are presented as number (%). All cases where ‘hospitalization’ or ‘visit the emergency room’ or ‘intervention (procedure or anticoagulation) was added’ within one month for the reasons listed in the table, Etc. contains dizziness or general weakness.