Prehab bundle cut lung surgery complications by half

Lung cancer surgery carries meaningful perioperative morbidity, including pulmonary complications and psychological distress, and recovery of physical function can be slow. Individual measures such as breathing exercises or nutritional support are commonly offered, but whether bundling them into a coordinated interdisciplinary programme delivers better outcomes than usual care has not been well tested. This is a question about whether preparing the body and mind before an operation changes what happens afterwards. It matters beyond oncology, because the same logic — condition the patient first — is being applied across surgical medicine.

This single-centre randomised controlled trial enrolled 240 patients undergoing lung cancer surgery between March 2021 and December 2023, randomised 1:1 to an interdisciplinary integrated care intervention (n = 120) or standard care (n = 120). The intervention combined pre-operative pulmonary rehabilitation, psychological support, nutritional optimisation and enhanced postoperative recovery protocols. The primary outcome was postoperative length of hospital stay. Secondary outcomes included postoperative pulmonary complications, pain scores, functional recovery measured by 6-minute walk distance, psychological status using the HADS, and quality of life via the QLQ-C30, with intention-to-treat as the primary analysis.

Length of stay was 7.43 ± 1.94 days in the intervention group versus 9.02 ± 2.30 days in controls, a mean difference of 1.59 days with a Cohen's d of 0.75; adjusting for a baseline FEV1 imbalance barely changed this at 1.54 days. Postoperative pulmonary complications occurred in 12.0% of the intervention group versus 26.1% of controls, a relative risk of 0.46. Functional recovery favoured the intervention with 6-minute walk distance differences of 57.77 m at 1 month and 61.97 m at 3 months, both above the minimal clinically important difference of 22-42 m. Anxiety and depression scores and quality of life were also significantly better.

The findings support the broader move towards comprehensive perioperative care programmes and prehabilitation, adding a reasonably sized randomised trial to a field where the effectiveness of multi-component models had been insufficiently studied. Because the intervention bundled rehabilitation, psychology, nutrition and postoperative protocols together, the trial cannot say which ingredient carried the effect, or whether the whole package was needed. It is also a single centre, so how well the model travels to other systems is unknown. The consistency across length of stay, complications, walk distance and mood is nonetheless notable.

For anyone facing major surgery, this is a reason to think that the weeks before an operation are not dead time — physical conditioning, nutrition and psychological preparation together were associated with a shorter stay and fewer lung complications here. The 6-minute walk gains at one and three months suggest the benefit is not just about the hospital ward but about how quickly ordinary function returns. It is one trial in one hospital, and it concerns a specific surgical population. Still, it illustrates the general principle that fitness going into a stressor influences what comes out the other side.