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Fujimoto S1,2, Nakayama T1
1Kyoto University Graduate School of Public Health, Health Informatics, Kyoto, Japan, 2Toyotsu All Life, Department of Healthcare, Tokyo, Japan
Background: Surgical operation for lung cancer poses the risks of postoperative pulmonary complications and mortality. The effectiveness of rehabilitation for preventing pulmonary complications after lung surgery has been examined. Most prior studies on the effect of rehabilitation on postoperative pulmonary complications after lung cancer surgery are controlled trials limited to experimental studies, and investigations using administrative claims data are unreported.
Purpose: To examine the effect of rehabilitation conducted both before and after lung cancer surgery on postoperative pulmonary complications, in comparison with rehabilitation conducted only before or after surgery and no rehabilitation.
Methods: This report is based on the Reporting Studies Conducted Using Observational Routinely Collected Health Data (RECORD) Statement. A retrospective cohort study was conducted to examine the effect of rehabilitation conducted before and after lung cancer surgery on the causes of postoperative pneumonia. Data were collected from the Diagnosis Procedure Combination (DPC) database, which provided patients with the opportunity to opt out. Hospitalized patients who received operative treatment for a new primary disease (ICD code C34) were selected. The inclusion criteria were pneumonectomy, malignant tumor surgery for the lung (thoracotomy), or thoracoscopic surgery (endoscopic; treatment codes K511-00, K513-00~03, and K514-00, 02). The exclusion criteria were lung transplantation (treatment code K514-03~06), suspected diagnosis of pneumonia, and pneumonia within 3 months before being diagnosed as having lung cancer. The main outcome was onset of postoperative pneumonia. Statistical analysis was performed using a multiple logistic regression model, with sex, age, cancer stage, activities of daily living on admission, amount of rehabilitation, comorbidities on admission, smoking index, and Hugh-Jones classification as confounders after adopting multiple imputation on missing data. The imputation method used a Markov Chain Monte Carlo technique and we generated 20 imputed data sets. These analyses were used for STATA 15 (Stata Corp LCC) and JMP pro13 (SAS Institute Inc.).
Results: Among 76,739 lung cancer patients, 15,146 who underwent lung cancer surgery were included in the analysis. Of these patients, 2,483 (16.4%) developed pneumonia. Patients were divided into four groups based on rehabilitation implementation patterns: combination 4,729 (33.4%), preoperative 269 (1.8%), postoperative 2,105 (13.9%), and no rehabilitation 8,043 (53.1%)”. Postoperative pneumonia occurred in 478 (10.0%), 61 (22.3%), 366 (17.2%), and 1621 (19.8%) patients in the combination, preoperative, postoperative, and no rehabilitation groups, respectively. Multiple logistic regression analysis revealed that the onset of pneumonia was less frequent in the combination group than in the preoperative (odds ratio [OR], 95% confidence interval [CI]: 2.8, 1.8-4.4), postoperative (OR: 1.9, 95% CI: 1.6-2.3), and no rehabilitation groups (OR: 2.5, 95% CI: 2.1-2.8). The postoperative group had a significantly lower incidence of pneumonia than the no rehabilitation group (OR: 1.3, 95% CI: 1.1-1.5). No significant difference in the onset of pneumonia was found between the preoperative and no rehabilitation groups, and between the postoperative and preoperative groups.
Conclusion(s): The combination rehabilitation significantly prevented postoperative pneumonia as compared with preoperative, postoperative, or no rehabilitation.
Implications: The present study suggests that a combination of preoperative and postoperative pulmonary rehabilitation might prevent postoperative pneumonia after lung cancer surgery.
Keywords: Big data, Cancer rehabilitation, Lung cancer
Funding acknowledgements: The present study was not funded.
Purpose: To examine the effect of rehabilitation conducted both before and after lung cancer surgery on postoperative pulmonary complications, in comparison with rehabilitation conducted only before or after surgery and no rehabilitation.
Methods: This report is based on the Reporting Studies Conducted Using Observational Routinely Collected Health Data (RECORD) Statement. A retrospective cohort study was conducted to examine the effect of rehabilitation conducted before and after lung cancer surgery on the causes of postoperative pneumonia. Data were collected from the Diagnosis Procedure Combination (DPC) database, which provided patients with the opportunity to opt out. Hospitalized patients who received operative treatment for a new primary disease (ICD code C34) were selected. The inclusion criteria were pneumonectomy, malignant tumor surgery for the lung (thoracotomy), or thoracoscopic surgery (endoscopic; treatment codes K511-00, K513-00~03, and K514-00, 02). The exclusion criteria were lung transplantation (treatment code K514-03~06), suspected diagnosis of pneumonia, and pneumonia within 3 months before being diagnosed as having lung cancer. The main outcome was onset of postoperative pneumonia. Statistical analysis was performed using a multiple logistic regression model, with sex, age, cancer stage, activities of daily living on admission, amount of rehabilitation, comorbidities on admission, smoking index, and Hugh-Jones classification as confounders after adopting multiple imputation on missing data. The imputation method used a Markov Chain Monte Carlo technique and we generated 20 imputed data sets. These analyses were used for STATA 15 (Stata Corp LCC) and JMP pro13 (SAS Institute Inc.).
Results: Among 76,739 lung cancer patients, 15,146 who underwent lung cancer surgery were included in the analysis. Of these patients, 2,483 (16.4%) developed pneumonia. Patients were divided into four groups based on rehabilitation implementation patterns: combination 4,729 (33.4%), preoperative 269 (1.8%), postoperative 2,105 (13.9%), and no rehabilitation 8,043 (53.1%)”. Postoperative pneumonia occurred in 478 (10.0%), 61 (22.3%), 366 (17.2%), and 1621 (19.8%) patients in the combination, preoperative, postoperative, and no rehabilitation groups, respectively. Multiple logistic regression analysis revealed that the onset of pneumonia was less frequent in the combination group than in the preoperative (odds ratio [OR], 95% confidence interval [CI]: 2.8, 1.8-4.4), postoperative (OR: 1.9, 95% CI: 1.6-2.3), and no rehabilitation groups (OR: 2.5, 95% CI: 2.1-2.8). The postoperative group had a significantly lower incidence of pneumonia than the no rehabilitation group (OR: 1.3, 95% CI: 1.1-1.5). No significant difference in the onset of pneumonia was found between the preoperative and no rehabilitation groups, and between the postoperative and preoperative groups.
Conclusion(s): The combination rehabilitation significantly prevented postoperative pneumonia as compared with preoperative, postoperative, or no rehabilitation.
Implications: The present study suggests that a combination of preoperative and postoperative pulmonary rehabilitation might prevent postoperative pneumonia after lung cancer surgery.
Keywords: Big data, Cancer rehabilitation, Lung cancer
Funding acknowledgements: The present study was not funded.
Topic: Cardiorespiratory; Oncology, HIV & palliative care; Cardiorespiratory
Ethics approval required: Yes
Institution: Kyoto University Graduate School of Medicine
Ethics committee: The ethics committees of Kyoto University Graduate School
Ethics number: R1376
All authors, affiliations and abstracts have been published as submitted.
