Impact of real-world pulmonary prehabilitation classes on lung cancer surgery patients’ outcomes: Matched-case analysis

Pulmonary rehabilitation (PR) classes for COPD patients are widely available across the UK and have been shown to improve outcomes, including recovery from exacerbation. Many lung cancer (LC) surgery patients have COPD and surgery could be considered a fixed COPD exacerbation. It’s uncertain in real-world practice whether referral to pulmonary prehabilitation (PP) classes improves surgical and patient-reported outcomes. We aim to answer this question by performing a propensity-score analysis (PSA) of participants in an enriched cohort study (10/H1208/41). <bold>Methods</bold> An enriched cohort study offering PR pre and post-surgery pragmatically by local providers in patients undergoing LC resection compared to a contemporaneous control group who just had usual care. The study recruited 873 patients (Prehabilitation (PG)n=135, control (CG)n=738). Regression exposed and unexposed matching, effect-estimate, and standard-errors calculations were performed. <bold>Results</bold> 118 participants were matched PG (n=59) CG (n=59). The multivariate-linear regression indicated a reduction in length of stay by 33% (95% CI: -2.2, 1.6) for the PG (EE- 0.33) Table (1). The multivariate log-binomial regression revealed no difference in btoperative pulmonary complications rate (EE 0.03). Lastly, the multivariate-linear regression showed an improvement in quality of life 5 months after surgery by 3.5% in the PG (EE 3.5), with the maximum improvement of 10 units (95%CI = -3.4, 10), considered clinically meaningful. <bold>Conclusion:</bold> Engagement in ‘real world’ PP before surgery appears to result in better patient and clinical outcomes after LC surgery. However, timely access to PP remains a real issue post-COVID.