{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T05:24:23Z","timestamp":1786944263394,"version":"build-2736575974"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100014718","name":"Innovative Research Group Project of the National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["32270690"],"award-info":[{"award-number":["32270690"]}],"id":[{"id":"10.13039\/100014718","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004829","name":"Science and Technology Department of Sichuan Province","doi-asserted-by":"publisher","award":["26QNJJB0145, 2024YFHZ0205"],"award-info":[{"award-number":["26QNJJB0145, 2024YFHZ0205"]}],"id":[{"id":"10.13039\/501100004829","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Frail elderly patients undergoing hepatobiliary-pancreatic (HBP) surgery face a substantially elevated risk of postoperative pulmonary complications (PPCs), which are associated with increased mortality, extended morbidity, and greater healthcare costs. Although the \u201cI Cough\u201d pulmonary rehabilitation program is a well-established preventive strategy for PPCs, its clinical effectiveness is often limited by suboptimal patient adherence. This randomized controlled trial was therefore conducted to determine whether a nurse-led intensive pulmonary rehabilitation exercises (IPREs) program could improve compliance and reduce the occurrence of PPCs in this highly susceptible population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 160 participants were randomly assigned to two groups. Eighty patients in the intervention (IPREs) group received IPREs, whereas 80 patients in the control group underwent conventional self-pulmonary rehabilitation training. The incidences of PPCs and other postoperative outcomes were compared between the two groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The median compliance rate with pulmonary rehabilitation exercises was significantly higher in the IPREs group than in the control group (100.00% [IQR 83.33\u2013100.00%] vs. 33.33% [IQR 33.33\u201366.67%];\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt;\u00a00.001). The incidence of PPCs was significantly lower in the IPREs group (22.50% vs. 38.75%; OR 0.459, 95% CI 0.230\u20130.926; P\u00a0=\u00a00.026), with notably reduced rates of pneumonia and atelectasis (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.05). The overall rate of major complications was also reduced in the IPREs group (12.50% vs. 25.00%; OR 0.429, 95% CI 0.186\u20130.989; P\u00a0=\u00a00.043). Additionally, the median postoperative hospital stay was shorter in the IPREs group (6 days [IQR 5\u20138] vs. 8 days [IQR 6\u20139];\n                      <jats:italic>P<\/jats:italic>\n                      =\u00a00.035).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The nurse-led intensive pulmonary rehabilitation program significantly improved compliance with pulmonary rehabilitation exercises, reduced the incidence of PPCs, and shortened postoperative hospitalization in frail elderly patients undergoing HBP surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registration<\/jats:title>\n                    <jats:p>\n                      <jats:uri>https:\/\/www.chictr.org.cn<\/jats:uri>\n                      , identifier ChiCTR2000040021.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1791031","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T04:31:21Z","timestamp":1786941081000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of an intensive pulmonary rehabilitation program on postoperative pulmonary complications in frail elderly patients undergoing hepatobiliary and pancreatic surgery: a randomized controlled trial"],"prefix":"10.3389","volume":"16","author":[{"given":"Jinhua","family":"Feng","sequence":"first","affiliation":[{"name":"Department of Biliary Surgery, West China School of Medicine, West China Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"West China School of Nursing, Sichuan University","place":["Chengdu, China"]},{"name":"Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, 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China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Biliary Surgery, West China School of Medicine, West China Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"West China School of Nursing, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanchun","family":"Ling","sequence":"additional","affiliation":[{"name":"Department of Biliary Surgery, West China School of Medicine, West China Hospital, Sichuan University","place":["Chengdu, China"]},{"name":"West China School of Nursing, Sichuan University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haijie","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Biliary Surgery, West China School of Medicine, West China Hospital, Sichuan University","place":["Chengdu, 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