Effects of an intensive pulmonary rehabilitation program on postoperative pulmonary complications in frail elderly patients undergoing hepatobiliary and pancreatic surgery: a randomized controlled trial

Background 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 “I Cough” 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. Methods 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. Results The median compliance rate with pulmonary rehabilitation exercises was significantly higher in the IPREs group than in the control group (100.00% [IQR 83.33–100.00%] vs. 33.33% [IQR 33.33–66.67%]; P < 0.001). The incidence of PPCs was significantly lower in the IPREs group (22.50% vs. 38.75%; OR 0.459, 95% CI 0.230–0.926; P = 0.026), with notably reduced rates of pneumonia and atelectasis ( P < 0.05). The overall rate of major complications was also reduced in the IPREs group (12.50% vs. 25.00%; OR 0.429, 95% CI 0.186–0.989; P = 0.043). Additionally, the median postoperative hospital stay was shorter in the IPREs group (6 days [IQR 5–8] vs. 8 days [IQR 6–9]; P = 0.035). Conclusions 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. Clinical trial registration https://www.chictr.org.cn , identifier ChiCTR2000040021.