Associations of latent profiles of resilience and fear of progression with discharge symptoms and postoperative frailty among patients undergoing lung resection: A longitudinal study.

BACKGROUND

To identify latent profiles of resilience and fear of progression in patients undergoing lung resection and evaluate their relationships with discharge symptoms and postoperative frailty.

METHODS

This two-wave longitudinal observational study enrolled 387 patients undergoing video-assisted thoracic surgery. Preoperative psychological constructs (resilience and fear of progression) were assessed at admission (T1), while postoperative symptoms and frailty status were evaluated at the time of discharge (T2). Latent profile analysis and the robust three-step approach were used to identify unobserved patient subgroups. Multivariable linear and logistic regression analyses were then applied to evaluate the independent associations between these psychological profiles and discharge symptom burden as well as postoperative frailty status, after adjusting for perioperative clinical covariates.

RESULTS

Three distinct profiles were identified: "Low Resilience-High Fear Group" (Profile 1, 24.3%), "Balanced Group" (Profile 2, 39.0%), and "High Resilience-Low Fear Group" (Profile 3, 36.7%). Living alone was a significant covariate associated with profile membership (P < 0.05). For discharge symptoms, using Profile 1 as the reference, membership in Profile 2 (b = -4.89) and Profile 3 (b = -16.95) was significantly associated with lower symptom scores (both P < 0.05). Regarding postoperative frailty at discharge, patients in Profile 3 had a 77% lower likelihood of worsening frailty status than those in Profile 1 (OR = 0.23, 95% CI: 0.13-0.40, P < 0.001). Additionally, primary caregiver type, preoperative frailty, and surgical procedures were independently related to discharge frailty status (all P < 0.05).

CONCLUSIONS

Preoperative psychological stratification serves as an independent indicator of discharge symptoms and frailty status. These findings confirm that classification based on psychological variables provides critical clinical information not captured by standard surgical indices. Prioritizing psychological risk stratification in thoracic surgical workflows is necessary to guide targeted perioperative interventions and improve recovery outcomes.