DOI: 10.1097/js9.0000000000005483 ISSN: 1743-9159

Home-based trimodal prehabilitation before lung resection: a single-center randomized controlled trial

Mariko Sato, Mitsuru Ida, Masatsugu Hamaji, Yukio Fujita, Masahiko Kawaguchi
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Background:

Perioperative sleep may affect surgical outcomes; however, the effects of prehabilitation on objective perioperative sleep indices remain unclear. In this randomized clinical trial, we evaluated whether a prehabilitation program could improve objective sleep indices and patient-reported outcomes in patients undergoing lung resection.

Materials and methods:

Patients scheduled for elective lung resection were randomized to prehabilitation or standard care. The intervention consisted of a 2-week home-based program, including exercise training, nutritional support, and relaxation strategies. Sleep parameters were assessed using actigraphy, with the primary endpoint defined as sleep efficiency on the night before surgery. The main secondary outcomes were other actigraphy-derived sleep indices, postoperative quality of recovery assessed using the Quality of Recovery-15 (QoR-15), postoperative morbidity evaluated using the Comprehensive Complication Index (CCI), and functional status at 3 months assessed using the 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0).

Results:

Of 187 screened patients, 62 were randomized to prehabilitation ( n = 31) or standard care ( n = 31). After excluding dropouts, 29 patients in the intervention group and 30 in the control group were included in the analysis. Among the 59 participants (mean age: 70 years), 55% were female. Objective sleep parameters, including sleep efficiency, did not differ significantly between groups. The prehabilitation group had higher QoR-15 scores [adjusted mean difference: 12.2; 95% confidence interval (CI) 0.4–24.0] and a lower CCI (adjusted mean difference: −4.6; 95% CI: −9.2 to −0.03). WHODAS 2.0 scores did not significantly differ between groups (adjusted mean difference: 2.1; 95% CI: −4.4 to 8.8).

Conclusion:

A 2-week home-based trimodal prehabilitation program did not improve objective sleep indices in patients undergoing lung resection. However, the intervention was associated with improved postoperative recovery and a lower overall morbidity burden.

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