Physical activity after video-assisted thoracoscopic lung resection following an enhanced recovery after surgery-based protocol: first data from a prospective observational study.

BACKGROUND

Early postoperative physical activity (PPA) is crucial for recovery and complication prevention after lung surgery. This study evaluates PPA in patients undergoing video-assisted thoracoscopic (VATS) lung resection within an enhanced recovery after surgery (ERAS) protocol.

METHODS

The Pulmonary Function after Thoracic Surgery (PATHOS) trial was a prospective, single-arm, single-center observational study that measured PPA of 62 patients scheduled for VATS lung resection between April 2022 and July 2023. A wrist-worn activity tracker was used to determine PPA until discharge or for a maximum of 5 postoperative days (PODs).

RESULTS

The median number of steps on POD 1 was 247 [34-616] and increased to 4,455 [2,099-5,514] on POD 5 (P<0.001). The median duration of PPA on POD 1 was 2 [0-4] minutes and increased to 37 [15-48] minutes on POD 5 (P<0.001). For 11 (17.7%) patients, zero steps were recorded on POD 1. Both the daily number of steps (P<0.001) and the duration of PPA (P=0.001) approximately tripled after chest tube removal. No complications ≥ grade 3 were observed.

CONCLUSIONS

Chest tube removal has a major impact on postoperative mobilization after thoracoscopic lung resection. However, the general level of PPA in this study was low despite an ERAS setting. Further studies are needed to determine what level of PPA is required to improve patient outcomes and how ERAS-based protocols can contribute to these efforts.