The Impact of Postoperative Pulmonary Complications on Short-Term Health-Related Quality of Life in Older Adults (Aged 60-80 Years) Undergoing Surgery for Early-Stage Lung Cancer.

Abstract

To evaluate the impact of postoperative pulmonary complications (PPCs) on short-term health-related quality of life (HRQOL) in older adults (60-80 years) with early-stage nonsmall cell lung cancer (NSCLC) after video-assisted thoracic surgery (VATS). A total of 261 patients with stage I NSCLC were enrolled. PPCs (defined according to European Perioperative Clinical Outcome criteria and graded using the Kroenke score) occurred in 72 (27.6%). The MD Anderson Symptom Inventory for Lung Cancer (MDASI-LC) longitudinally assessed symptoms and recovery trajectories at preoperative baseline, discharge, and post-discharge (days 7, 30, 60, and 90). Multivariable Cox regression identified delayed-recovery predictors. Patients with PPCs had prolonged median hospitalization (median 6 days, interquartile range [IQR]: 4-9 vs. 4 days, IQR: 3-5; p < 0.001). At discharge, the PPCs group showed significantly higher MDASI-LC scores across seven items (adjusted mean differences: +0.46 to +0.67; all p < 0.05, Bonferroni-adjusted) except coughing. During the 90-day follow-up, the PPCs group exhibited persistently elevated coughing (day 30: +0.56) and shortness of breath (day 7: +0.52; day 60: +0.66; all p < 0.05). Kaplan-Meier analysis confirmed delayed recovery with PPCs for shortness of breath (median 88 vs. 58 days), coughing (95 vs. 70 days), and activity interference (94 vs. 86 days) (all p < 0.05). Multivariable Cox regression demonstrated PPCs independently delayed recovery (adjusted hazard ratios [aHRs]: 0.442-0.535), while lobectomy (vs. sublobectomy) increased risk (aHRs: 0.535-0.659). Subgroup analysis stratified by surgical extent and PPCs status revealed synergistic effects: VATS lobectomy with PPCs showed slowest recovery (shortness of breath: median 88 days, coughing: 95 days and activity interference: 94 days), while sublobectomy without PPCs had fastest recovery (shortness of breath: 54 days, coughing: 58 days and activity interference: 71 days; all p < 0.05, Bonferroni-adjusted). PPCs significantly extend hospitalization and delay recovery of respiratory symptoms (shortness of breath, coughing) and activity interference in older NSCLC patients after VATS. The synergistic effect of lobectomy and PPCs exacerbates delays. Prioritizing sublobectomy when oncologically feasible, and implementing aggressive PPC prevention for lobectomy candidates, optimizes postoperative HRQOL.