Impacts of different preoperative pulmonary exercise initiating time on postoperative recovery in elderly patients with lung cancer: an exploratory retrospective study

This study aimed to compare two care pathways for initiating preoperative pulmonary exercise in elderly patients scheduled for lung cancer surgery. An exploratory retrospective review was conducted on elderly patients who underwent lung cancer surgery between January and December 2024. Data collected included age, sex, smoking history, health insurance status, cancer type, cancer stage, type of surgery, baseline pulmonary function, and timing of pulmonary exercise initiation. Patients were categorized into a admission-initiation group (exercise initiated upon hospital admission) and a clinic-initiation group (exercise initiated in the outpatient clinic upon surgical decision). Postoperative outcomes—including pulmonary function, length of hospital stay, and complication rates—were compared between the two groups. A total of 152 patients were included, with 76 in each group. Baseline characteristics were comparable, except for the duration of pulmonary exercise, which was significantly longer in the clinic-initiation group [11.0 (9.0, 16.5) vs. 2.0 (1.0, 4.0); p < 0.001]. Compared to the admission-initiation group, the clinic-initiation group demonstrated significantly better pulmonary function one day before surgery and three months postoperatively, shorter postoperative hospital stay, and a lower incidence of complications ( p = 0.049, 0.004, 0.021, and 0.025, respectively). Compared with initiating pulmonary exercise later during hospital admission, initiating exercise in the clinic at the time of surgical decision was associated with improved postoperative pulmonary function, reduced length of hospital stay, and lower risk of postoperative complications in elderly patients undergoing elective lung cancer surgery. Further prospective studies are warranted.