Video-assisted thoracoscopic surgery lobectomy: which patients require postoperative physiotherapy?

Background: Video-assisted thoracoscopic surgery (VATS) lobectomy for lung cancer is associated with a risk of postoperative pulmonary complications (PPC) with associated poor outcomes. Despite this, the provision of postoperative physiotherapy after VATS is variable. We aimed to identify baseline factors associated with problems amenable to physiotherapy after VATS lobectomy. Methods: The prospective cohort study included all cancer patients undergoing VATS lobectomy over 4 years (2012-2016). From postoperative day 1 (POD1), patients were sat out by nursing staff and assisted to mobilise. Physiotherapy assessment on POD1 determined presence of issues amenable to intervention, and treatment was commenced as deemed necessary. Outcome measures included PPC development, hospital and high dependency unit (HDU) length of stay (LOS), intensive therapy unit admission (ITU) and in-hospital mortality. Results: Of 285 patients, 209 (73%) received physiotherapy for reduced mobility, 23 (8%) received therapies sputum clearance and 65 (23%) for lung volume loss. The 76 (27%) patients not requiring physiotherapy had a reduced hospital and HDU LOS (p Conclusion: We have identified preoperative factors associated with issues amenable to physiotherapy following VATS lobectomy; these patients may benefit from pulmonary rehabilitation and physiotherapy for better postoperative outcome.