Structured Pulmonary Physiotherapy After Lung Cancer Surgery by Age Group

This ambispective observational cohort study evaluates age-related differences in clinical outcomes among patients undergoing lung cancer surgery who received a structured comprehensive in-patient physiotherapy (CIPT) program as part of standard postoperative care. Patients aged 45-90 years were included and classified into two predefined age groups: middle-aged (45-64 years) and older (65-90 years).

The CIPT program was initiated on the first day after transfer from the intensive care unit to the thoracic surgery ward and continued until hospital discharge. The program included patient education, breathing exercises, incentive spirometry, airway clearance techniques, early mobilization, postural exercises, and upper- and lower-extremity range-of-motion exercises. One session per day was supervised by a physiotherapist, with additional sessions performed independently by the patient or with caregiver assistance during hospitalization.

The primary outcome was hospital length of stay. Secondary outcomes included clinical parameters (blood pressure, resting heart rate, oxygen saturation, and respiratory rate), symptom-related outcomes (dyspnea, fatigue, and incisional pain), and inflammatory biomarkers (C-reactive protein [CRP], neutrophil-to-lymphocyte ratio [NLR], and albumin).

Outcomes were assessed during the postoperative inpatient period and compared between the predefined age groups. No randomization or non-intervention control group was included, as all participants received the same structured CIPT program as part of standard postoperative care.

Inclusion criteria

• Patients aged 45 to 90 years
• Undergoing lung cancer surgery (lobectomy, segmentectomy, or pneumonectomy)
• Medically stable in the early postoperative period
• Able to participate in a structured pulmonary physiotherapy program
• Provided written informed consent

Exclusion criteria

• Hemodynamic instability preventing mobilization
• Severe cognitive impairment limiting cooperation
• Neurological or orthopedic conditions restricting mobilization
• Requirement for prolonged mechanical ventilation
• Presence of another active malignancy
• Any medical contraindication to physiotherapy as determined by the attending physician