{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,17]],"date-time":"2026-01-17T19:11:14Z","timestamp":1768677074085,"version":"3.49.0"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,12,8]],"date-time":"2023-12-08T00:00:00Z","timestamp":1701993600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,12,8]],"date-time":"2023-12-08T00:00:00Z","timestamp":1701993600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Cardiothorac Surg"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Objective<\/jats:title>\n                <jats:p>Frailty develops as a result of age-related decline in many physiological systems and is associated with increased vulnerability to adverse outcomes following thoracic surgery. We prospectively tested our hypothesis that pre-operative pulmonary rehabilitation (Prehab) improves frailty, as suggested by a frailty index\u2009&gt;\u20093 (FI\u2009&gt;\u20093) and fitness, and thereby reduces the risk of post-surgical complications and death in vulnerable elderly lung cancer patients.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>221 surgical patients, 80 with FI\u2009&gt;\u20093 vs. 141 patients with FI\u2009&lt;\u20093, following Prehab proceeded to surgery. Their Frailty index (FI), dyspnoea scores, performance status (PS), level of activity (LOA) and six-minute walk test (6MWT) prior to and following Prehab were determined. The post-operative length of hospital stay (LOHS), complications, mortality and mid-term survival at 1100 days were compared. Similarly, outcomes for elderly patient\u2009\u2265\u200970 years with FI\u2009&gt;\u20093 (\u2265\u200970,FI\u2009&gt;\u20093) were compared with younger patients\u2009&lt;\u200970 years with FI\u2009\u2264\u20093 (&lt;\u200970,FI\u2009\u2264\u20093).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Patients with FI\u2009&gt;\u20093 were significantly older, had lower 6MWT and higher thoracoscores hence, 82.5% of patients with FI\u2009&gt;\u20093 vs. 33.3% (p\u2009=\u20090.02) with FI\u2009\u2264\u20093 were considered high risk for surgery and postoperative adverse events. With Prehab there was significant improvement in the FI, dyspnoea scores, PS, LOA and 6MWT. Following surgery, there were no differences in major complication rates (8.8% vs. 9.2% p\u2009=\u2009ns); LOHS median (IQR) [7 (6.8) vs. 8 (5.5) days]; mortality at 30-days (3.7% vs. 0.7%, p\u2009=\u2009ns); 90-days (6.3% vs. 2.8%, p\u2009=\u2009ns) and 1-year survival (81.1% vs. 83.7% p\u2009=\u2009ns). Survival at 1100 days was (63.2% vs. 71.1%, p\u2009=\u20090.19). Likewise, 87.7% elderly\u2009\u2265\u200970,FI\u2009&gt;\u20093 patients were considered high-risk for surgery and postoperative adverse events vs. 35.1% younger patients\u2009&lt;\u200970,FI\u2009\u2264\u20093 (p\u2009=\u20090.0001). Following Prehab and surgery, there were no significant differences in complications, LOHS, mortality at 365 days between the two groups. Survival at 1100 days for \u2265\u200970,FI\u2009&gt;\u20093 was 55.2% vs. 79.96% for &lt;\u200970,FI\u2009\u2264\u20093; (p\u2009=\u20090,01).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Our study suggests that Prehab optimises vulnerable high-risk elderly lung cancer patients with frailty allowing them to undergo surgery with outcomes of post-surgical complications, LOHS and mortality at 365 days no different to patients with no frailty. However, mid-term survival was lower for elderly patients with frailty.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13019-023-02433-9","type":"journal-article","created":{"date-parts":[[2023,12,8]],"date-time":"2023-12-08T11:02:45Z","timestamp":1702033365000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Pre-treatment optimisation with pulmonary rehabilitation of elderly lung cancer patients with frailty for surgery"],"prefix":"10.1186","volume":"18","author":[{"given":"Ira","family":"Goldsmith","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gemma","family":"Chesterfield-Thomas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hannah","family":"Toghill","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,12,8]]},"reference":[{"issue":"2","key":"2433_CR1","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1097\/01.SLA.0000081085.98792.3d","volume":"238","author":"DA Etzioni","year":"2003","unstructured":"Etzioni DA, Liu JH, Maggard MA, Ko CY. 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Nevertheless, the study was performed in accordance with the Declaration of Helsinki and verbal consent obtained from each participant as part of provision of service.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}}],"article-number":"356"}}