Effectiveness of an Interdisciplinary Integrated Care Model on Perioperative Outcomes in Patients Undergoing Lung Cancer Surgery: A Randomized Controlled Trial.

BACKGROUND

Lung cancer surgery is associated with significant perioperative morbidity, including pulmonary complications and psychological distress. The effectiveness of comprehensive interdisciplinary care models in improving outcomes remains insufficiently studied.

METHODS

This single-center randomized controlled trial enrolled 240 patients undergoing lung cancer surgery between March 2021 and December 2023. Patients were randomized 1:1 to receive either an interdisciplinary integrated care intervention (n = 120) or standard care (n = 120). The intervention included preoperative pulmonary rehabilitation, psychological support, nutritional optimization, and enhanced postoperative recovery protocols. The primary outcome was postoperative length of hospital stay (LOS). Secondary outcomes included postoperative pulmonary complications (PPCs), pain scores, functional recovery (6-min walk distance), psychological status (HADS), and quality of life (QLQ-C30). Intention-to-treat analysis was performed as the primary analysis.

RESULTS

In the ITT analysis, the intervention group had significantly shorter LOS compared to control (7.43 ± 1.94 vs. 9.02 ± 2.30 days; mean difference 1.59 days, 95% CI: 1.07-2.12; p < 0.001; Cohen's d = 0.75). After adjusting for baseline FEV1 imbalance, the difference remained significant (adjusted mean difference 1.54 days, 95% CI: 1.02-2.06; p < 0.001). PPCs were significantly lower in the intervention group (12.0% vs. 26.1%; RR = 0.46, 95% CI: 0.26-0.81; p = 0.008). The intervention group demonstrated superior functional recovery, with 6-min walk distance differences of 57.77 m at 1 month and 61.97 m at 3 months, both exceeding the minimal clinically important difference of 22-42 m. Psychological outcomes (HADS-anxiety: 4.19 ± 2.55 vs. 6.48 ± 3.22; HADS-Depression: 3.57 ± 1.97 vs. 5.19 ± 2.89 at 3 months; both p < 0.001) and quality of life were significantly improved.

CONCLUSIONS

An interdisciplinary integrated care model significantly reduces hospital stay, decreases pulmonary complications, and improves functional and psychological outcomes in patients undergoing lung cancer surgery. These findings support the implementation of comprehensive perioperative care programs.