Article Abstract

Effectiveness of pulmonary rehabilitation and correlations in between functional parameters, extent of thoracic surgery and severity of post-operative complications: randomized clinical trial

Authors: Attila Vagvolgyi, Zsolt Rozgonyi, Maria Kerti, George Agathou, Paul Vadasz, Janos Varga

Abstract

Background: Pulmonary rehabilitation can be effective in perioperative condition. Our aim was to examine whether the changes of functional markers are significant and search connections between these values and the severity of postoperative complications.
Methods: A total of 238 chronic obstructive pulmonary disease (COPD) patients underwent perioperative pulmonary rehabilitation with thoracic surgery. Health status and the following parameters were examined: lung function (FEV1, FVC), chest kinematics [chest wall expansion (CWE)], 6-minute walking test (6MWT), breath holding time (BHT), grip strength (GS) and exercise capacity. Patients were separated into three groups: 72 patients had preoperative rehabilitation only (PRE group), 80 had only postoperative rehabilitation (POS group), and 86 patients underwent pre- and postoperative rehabilitation as well (PPO group). Postoperative complications were classed as “severe” and “not severe”. We evaluated the changes in functional parameters. Significance was recognized at P<0.05. Connections in between variables and severity of complications were analyzed.
Results: Pulmonary rehabilitation resulted significant changes of all examined parameters in all three groups. The direction of changes were favourable, so all of the changes can be considered to be improvement [PRE: CWE: 4.2±2.3 vs. 5.8±2.2 cm; 1: 63.2±15.6 vs. 70.1±16.6 %pred; 6-minute walking distance (6MWD): 392.9±93.5 vs. 443.2±86.6 m; FVC: 83.1±15.9 vs. 90.9±15.6 %pred; POS: CWE: 2.9±1.4 vs. 5.0±2.0 cm; 1: 56.4±15.6 vs. 64.6±16.0 %pred; 6MWD: 354.7±90.7 vs. 437.0±96.0 m; FVC: 66.2±18.7 vs. 76.1±17.7 %pred; PPO: preoperatively: CWE: 4.0±2.1 vs. 5.6±2.6 cm; 1: 58.2±15.1 vs. 67.0±14.6 %pred; 6MWD: 378.3±90.5 vs. 441.3±86.4 m; FVC: 82.4±16.7 vs. 93.3±16.7 %pred; postoperatively: CWE: 2.7±1.5 vs. 4.4±2.2 cm; 1: 47.4±13.0 vs. 53.4±14.7 %pred; 6MWD: 341.4±115.9 vs. 403.3±98.4 m; FVC: 63.6±16.9 vs. 72.6±18.6 %pred; P<0.05]. BHT, GS, dyspnoea and health status were also improved significantly. By discriminant analysis 5 of the variables proved to have discriminative value: kilometers travelled via cycle ergometer at the onset of the preoperative rehabilitation, gender, 1 after preoperative rehabilitation, extent of the operation and 6MWD before preoperative rehabilitation. These 5 parameters can predict severe complications correctly in 72.5% of all cases.
Conclusions: Pulmonary rehabilitation can reduce the functional depletion caused by the thoracic surgical operation. Identification of more predictive factors of severe complications can help making preoperative risk stratification more precisely.