Background/Objectives: Chronic obstructive pulmonary disease (COPD) coexists with lung cancer in 40–70% of cases and increases perioperative risk, particularly in patients with severely impaired pulmonary function. Preoperative pulmonary rehabilitation (PR) has been proposed as a perioperative optimization strategy; however, its effect on hospital length of stay (LOS) in patients with advanced COPD remains unclear. This study aimed to compare postoperative complications, intensive care unit (ICU) utilization, and hospital LOS between patients with lower and higher baseline forced expiratory volume in one second (FEV1), and to evaluate the role of preoperative PR as a risk-adaptive perioperative strategy in high-risk COPD patients undergoing lung cancer surgery. Methods: This retrospective cohort study comprises patients with spirometry-confirmed COPD and non-small cell lung cancer (NSCLC) who underwent elective lung resection at a tertiary care center between March 2019 and June 2020. Disease severity was classified using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) framework: GOLD 1–2 (FEV1 ≥ 50% predicted) and GOLD 3–4 (FEV1 < 50% predicted). Patients in the GOLD 3–4 group received a uniform 15-day hospital-based preoperative PR program prior to surgery. Primary outcomes were ICU stay, postoperative complications, and hospital LOS. Factors independently associated with prolonged hospital stay were examined using an exploratory multivariable linear regression model. Results: Among 63 patients (95.2% male; median age 64 years), those with GOLD 3–4 COPD had significantly lower baseline FEV1 values and longer COPD duration compared with the GOLD 1–2 group. Despite a higher perioperative risk profile, postoperative complication rates (28.6% overall; p = 0.237) and ICU utilization were comparable between groups. Median postoperative hospital LOS was significantly longer in patients with GOLD 3–4 COPD (15 IQR 6 vs. 11 IQR 4 days; p < 0.001). In the exploratory regression analysis, lower predicted FEV1 percent (p = 0.003) and older age were independently associated with prolonged hospital stay, whereas PR was not an independent determinant of LOS. Conclusions: In patients with lung cancer and severe COPD (GOLD 3–4) who received preoperative PR, postoperative complication rates and ICU utilization were comparable to those observed in patients with less severe disease. Prolonged hospital stay in the high-risk group was independently associated with lower FEV1 and older age, reflecting underlying disease severity. Prospective controlled studies stratified by COPD severity are needed to establish the independent contribution of preoperative PR in this population.
İnan et al. (Thu,) studied this question.