Multimodal prehabilitation before lung resection surgery: a multicentre randomised controlled trial.

Area of Science:

• Cardiopulmonary exercise testing
• Thoracic surgery
• Prehabilitation protocols

Background:

• Respiratory muscle training may improve ventilatory efficiency (VE/VCO2 slope), a key predictor of postoperative pulmonary complications.
• High-risk patients undergoing lung resection face significant postoperative pulmonary complication risks.

Purpose of the Study:

• To investigate the efficacy of multimodal prehabilitation, incorporating high-intensity respiratory muscle training, in reducing postoperative complications and hospital stay after lung resection.
• To assess the impact of prehabilitation on ventilatory efficiency (VE/VCO2 slope) in high-risk surgical patients.

Main Methods:

• A prospective multicentre randomized controlled trial (NCT04826575) involving 122 high-risk patients undergoing lung resection.
• Participants received either usual care or a 14-day multimodal prehabilitation program including respiratory muscle training, smoking cessation, nutritional, and psychological support.
• High-risk status was defined by a VE/VCO2 slope ≥33 on cardiopulmonary exercise testing.

Main Results:

• Multimodal prehabilitation reduced postoperative pulmonary complications from 55% to 34% (OR 2.29, P=0.029).
• Hospital length of stay was shorter in the prehabilitation group (7 days vs. 9 days, P=0.038).
• Prehabilitation improved ventilatory efficiency (VE/VCO2 slope decreased from 39 to 36, P=0.01) and patient-reported quality of life.

Conclusions:

• Multimodal prehabilitation, including high-intensity respiratory muscle training, is effective in reducing postoperative pulmonary complications in high-risk patients undergoing lung resection.
• The intervention also leads to a shorter hospital stay and improved ventilatory efficiency.
• Targeting VE/VCO2 with prehabilitation offers a promising strategy for improving surgical outcomes.