title: Physiological rehabilitation after video-assisted lung lobectomy for cancer: a prospective study of measuring daily exercise and oxygenation capacity.
abstract: OBJECTIVE
  Video-assisted thoracic surgery followed by fast-track rehabilitation has been claimed to accelerate physiological recovery after lung lobectomy for cancer; however, we are still uncertain when the exercise and oxygenation capacity recover and how to determine the rehabilitation time required by each patient. The aim of this study was to evaluate the rehabilitation time after this type of surgery and determine the best predictors of rehabilitation time.
  
  
  METHODS
  We measured exercise and oxygenation capacity daily during the perioperative period on a prospective series of 40 patients who had scheduled to undergo video-assisted lung lobectomy for cancer. Postoperative rehabilitation was confirmed when patients had regained more than 80% of their baseline exercise capacity and more than 98% of their baseline oxygenation capacity without the use of routine tubes for oxygen supplementation, fluid transfusion, bladder catheterization, chest drainage, and epidural catheterization. The hypoxemia index, which we found to have correlated with early-postoperative oxygenation capacity, was calculated preoperatively using baseline arterial oxygen saturations and the severity of emphysema on computed tomography.
  
  
  RESULTS
  The median rehabilitation time was 3 days. Stepwise Cox regression analysis revealed that the postoperative predicted forced expiratory volume in 1s (relative ratio 1.043, p < 0.01) and the hypoxemia index (relative ratio 1.343, p = 0.02) were the best independent determinants of the postoperative rehabilitation time.
  
  
  CONCLUSIONS
  By conducting daily physiological assessments, we identified the rehabilitation time and its determinants in patients who underwent video-assisted lung lobectomy for cancer. Our results are valuable for planning patient-specific fast-track surgery in the hospital setting.
authors.affiliation: Department of Surgery and Clinical Science, Division of Chest Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan. kaueda@c-able.ne.jp
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Ueda
authors.forename: Manabu
authors.initials: M
authors.lastname: Sudoh
authors.forename: Mitsutaka
authors.initials: M
authors.lastname: Jinbo
authors.forename: Tao-Sheng
authors.initials: TS
authors.lastname: Li
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Suga
authors.forename: Kimikazu
authors.initials: K
authors.lastname: Hamano
mesh_terms: D000368:Aged; D015444:Exercise / Q000502:physiology*; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D000860:Hypoxia / Q000503:physiopathology; D008168:Lung / Q000601:surgery*; D008175:Lung Neoplasms / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D008297:Male; D010100:Oxygen / Q000502:physiology*; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications; D011446:Prospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010100:Oxygen