Multimodal prehabilitation before lung resection surgery: a multicentre randomised controlled trial.

Summary

In high-risk patients scheduled for lung resection, multimodal prehabilitation (including high-intensity respiratory muscle training) reduced postoperative pulmonary complications from 55% to 34% and shortened hospital stay from 9 to 7 days. The trial was prospectively registered and multicentre, supporting generalizability.

Key Findings

• Postoperative pulmonary complications were reduced with prehabilitation (34% vs 55%; OR 2.29; P=0.029).
• Hospital length of stay decreased from 9 to 7 days with prehabilitation (P=0.038).
• Intervention included high-intensity respiratory muscle training as part of a multimodal program.

Clinical Implications

Incorporate structured, multimodal prehabilitation (with high-intensity respiratory muscle training) into preoperative care for high-risk lung resection candidates to reduce PPCs and hospital length of stay.

Limitations

• Non-blinded design may introduce performance bias.
• Detailed physiologic endpoints are truncated in the abstract and may require full-text review for interpretation.

Future Directions

Define optimal components, intensity, and timing of prehabilitation; evaluate cost-effectiveness and scalability across healthcare systems; assess effects on specific complications (e.g., pneumonia, respiratory failure).