Early ambulation may lead to fewer postoperative complications. The investigators examined the effect of an aggressive ambulation program using a customized thoracic walker on the length of stay (LOS), pulmonary complications, and need for supplemental oxygen at time of discharge in patients undergoing lobectomy for clinical stage I NSCLC.
The investigators, retrospectively, compared 91 patients undergoing lobectomy for clinical stage I NSCLC: 64 from January, 2007, to January 2008, (control group underwent surgery prior to use of the walker); and 27 from May 2008 to February, 2009 (postoperative regimen included the walker). Demographics and preoperative conditions by cohort were compared via Fisher's exact or t-test. Linear regression was used to examine the effect of cohort on LOS. The effects of cohort on pulmonary complications and supplemental oxygen were analyzed using logistic regression. Propensity score was calculated using a logistic regression to balance the covariates known to influence postperative outcomes [gender, age, preoperative Forced Expiratory Volume (FEV1) and Charlson Comorbidity Index (CCI)] between cohorts. Propensity scores were grouped into quintiles and included in all the data models as a covariate.
Demographics (age, gender, pathologic stage, FEV1, CCI) were not different between groups. Mean LOS (+/− SD) was 5.2 (4.7) for all 91 patients, 4.9 (3.2) for controls and 5.9 (6.9) for the walker group, adjusted p = 0.68. Pulmonary complications occurred in 7/64 (11%) in the control group and 1/27 (4%) in the walker group, adjusted p = 0.31. Supplemental oxygen at discharge was needed for 9/64 (14%) control, and 2/27 (7%) in the walker group, adjusted p = 0.41. No adverse effect of aggressive ambulation was identified.
A trend toward decreased postoperative pulmonary complications and use of supplemental oxygen at the time of discharge was noted after we instituted an aggressive program of postoperative ambulation in patients undergoing thoracic surgery for lung cancer.
Future research may show significant results by involving multi-facilities, or changing comparison groups to the stage IIIA lung cancer patients, who have undergone tri-modality therapy.
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