Age-related effects of comprehensive in-patient physiotherapy after lung cancer surgery across age groups: an ambispective observational cohort study in middle-aged and older patients

Abstract

Abstract Background Postoperative recovery after lung cancer surgery may be influenced by age, comorbidity burden, and perioperative rehabilitation strategies. However, evidence regarding the age-related effects of structured early inpatient physiotherapy programs remains limited. This study aimed to evaluate the age-related effects of a comprehensive in patient physiotherapy (CIPT) program on hospital length of stay (LoS), clinical parameters, symptom-related outcomes, and inflammatory biomarkers in patients undergoing lung cancer surgery. Methods This ambispective observational cohort study included patients who underwent lung cancer surgery and received a structured CIPT program during the postoperative inpatient period as part of standard postoperative care. Participants were categorized into middle-aged and older groups. Outcomes included hospital LoS, clinical parameters (blood pressure, resting heart rate, oxygen saturation, and respiratory rate), symptom-related outcomes (dyspnea and fatigue with Modified Borg Scale, and incisional pain with Visual analog scale), and inflammatory biomarkers (C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and albumin). Pre- and post-program changes within groups and differences between age groups were analyzed. Results Median LoS was 7 [5–10] days in the middle-aged group and 7 [6–10] days in the older group, with no significant difference between groups. Significant improvements in resting heart rate, oxygen saturation, and dyspnea were observed in the older group, whereas dyspnea, fatigue, and incisional pain improved significantly in the middle-aged group. No significant differences were detected between age groups in clinical parameters or symptom-related outcomes. CRP and NLR levels decreased significantly in both groups, while albumin showed a non-significant upward trend over time. Despite a higher comorbidity burden in the older group, no adverse events or clinical instability were observed during the rehabilitation program. Conclusion The CIPT program appears to be safe and feasible for both middle-aged and older patients following lung cancer surgery. Similar outcomes between age groups suggest that age alone may not represent a barrier to participation in structured early inpatient rehabilitation programs. Early physiotherapy integrated into postoperative care pathways may facilitate recovery without increasing hospital length of stay across age groups, which may also help reduce the potential economic burden associated with prolonged hospitalization. Trial registration ClinicalTrials.gov, NCT07441863. First submitted on 17 February 2026 and first posted on 02 March 2026 retrospectively registered.