Perioperative Pulmonary Rehabilitation Interventions to Reduce Postoperative Pulmonary Complications After Thoracic Surgery

Abstract

Background:
Postoperative pulmonary complications are common after thoracic surgery and contribute to morbidity and longer hospital stay. Perioperative pulmonary rehabilitation aims to reduce these complications, but the relative benefit of different approaches is uncertain.
Methods:
PubMed was searched from inception to July 2025 for comparative clinical trials and cohort studies evaluating perioperative pulmonary rehabilitation interventions in adults undergoing thoracic surgery. Findings were synthesised narratively without meta-analysis; postoperative pulmonary complications were the primary outcome, with length of stay and functional recovery as secondary outcomes.
Results:
Eleven studies (eight randomised trials, two cohorts, one case-control; sample size range 12–1056) were included. Enhanced recovery after surgery plus pulmonary rehabilitation reduced postoperative pulmonary complications versus enhanced recovery alone (n=374; 18.7% vs 33.2%; hazard ratio 0.52, 95% confidence interval 0.35–0.79). Ultra-early post-anaesthesia care unit rehabilitation reduced atelectasis and/or pneumonia (n=900; 6.7% vs 11.4%; odds ratio 0.53, 95% confidence interval 0.26–0.98), preoperative high-intensity interval training reduced pulmonary complications (n=151; 23% vs 44%), and a pilot preoperative pulmonary rehabilitation programme shortened postoperative stay (7.8 ± 4.8 vs 12.2 ± 3.6 days).
Conclusions:
Bundled perioperative pulmonary rehabilitation, especially when integrated into enhanced recovery pathways and delivered with very early mobilisation, was associated with fewer postoperative pulmonary complications after thoracic surgery. Standardised endpoint definitions and pragmatic comparative trials are needed to refine patient selection and intervention dosing.