BACKGROUND: Postoperative pulmonary complications (PPCs) are a leading cause of morbidity and prolonged hospitalization after thoracic surgery. While pulmonary rehabilitation (PR) and noninvasive positive-pressure ventilation (NIPPV) have individually demonstrated benefits, evidence for their combined use, particularly with intermittent NIPPV, remains limited. This study aimed to evaluate the impact of PR combined with intermittent NIPPV on postoperative recovery. METHODS: This retrospective cohort study analyzed 135 thoracic surgery patients who received either PR alone (N.=78) or PR combined with intermittent NIPPV (N.=57). Outcomes included chest tube duration, hospital stay, bronchoscopy frequency, spirometric improvement, and 6-month pulmonary-related readmissions. RESULTS: Compared with PR alone, the PR + NIPPV group had shorter chest tube duration (5.42 +/- 2.14 vs. 6.61 +/- 4.12 days; P=0.03), shorter hospital stay (7.38 +/- 3.04 vs. 9.56 +/- 6.16 days; P=0.01), fewer bronchoscopies (0.51 +/- 0.89 vs. 1.04 +/- 1.36; P=0.01), and greater spirometric improvement (842 +/- 356 mL vs. 713 +/- 287 mL; P=0.03). Readmission rates showed no significant difference between groups (P=0.13). CONCLUSIONS: Integrating intermittent NIPPV into standard PR protocols appears to enhance postoperative pulmonary recovery, shortens hospital stay, and reduces bronchoscopy needs, while maintaining good tolerability. This combined approach merits considered for thoracic surgery patients, particularly those at high risk for PPCs. (Cite this article as: Chen HJ, Wu WL, Chung WC, Tsai JR, Tsai PC, Lin CC, et al. Intermittent noninvasive positive-pressure ventilation combined with pulmonary rehabilitation enhances postoperative recovery in thoracic surgery patients: a retrospective study. Minerva Respir Med 2026;65:7-13. DOI: 10.23736/S2784-8477.26.02237-0)
BACKGROUND: It is known that comorbidities associated with chronic obstructive pulmonary disease (COPD) can influence its course. However, according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, it is not clear which can affect the disease exacerbations in group E patients being regularly treated with single inhaler triple therapy (SITT). METHODS: We retrospectively extracted from our database SITT individuals treated with fluticasone furoate/vilanterol/umeclidinium (FF/UMEC/VI) or beclometasone dipropionate/formoterol fumarate/glycopyrronium (BDP/FF/GLI) for 1 year. Only patients who were prescribed more than 7 triple-therapy packages/year were considered. At least 3 oral corticosteroid (OC) packages prescribed during the triple treatment were used to identify COPD exacerbations. RESULTS: The number of patients enrolled on SITT therapy for 1 year was 5107 (1844-36.1%/females; 3263-63.9%/males; mean age: 74.9 +/- 9.3). SITT treatment adherence, i.e., triple therapy packages/year, was 10.8 +/- 2.9. The most common comorbidities associated to COPD were cardiovascular diseases (CVD - 73.4%), hypertension HYP (71.8%), and gastroesophageal reflux/dyspepsia (GER/D - 63.1%) and then all the others. Comorbidities increasing the risk of having >= 3 OC packages/year were: CVD (OR: 1.242 [95% CI: 1.033-1.494]; P=0.021), GER/G (OR: 3.164 [95% CI: 2.702-3.717]; P=0.0001), psychiatric disorders (OR: 1.751 [95% CI: 1.508-2.036]; P=0.0001), oncological diseases (OR: 2.227 [95% CI: 1.890-2.617]; P=0.0001), anemia (OR: 1.283 [95% CI: 1.046-1.577]; P=0.017), osteoporosis (OP) (OR: 1.631 [95% CI: 1.261-2.114]; P=0.0001), autoimmune diseases (OR: 1.748 [95% CI: 1.251-2.444]; P=0.001) and chronic kidney diseases (OR: 2.247 [95% CI: 1.453-3.412]; P=0.0001). Conversely, the association of COPD and HYP (OR: 0.788 [95% CI: 0.671-0.926]; P=0.004) and dyslipidemia (DYS) (OR: 0.753 [95% CI: 0.646-0.877]; P=0.0001) significantly reduced the exacerbation risk. CONCLUSIONS: In conclusion, in GOLD-Group E, many comorbidities are associated with increased risk of COPD exacerbations despite SITT. GER/D was the disease leading to a greater exacerbation risk. Conversely, HYP/DYS associations were protective against them. In higher risk patients, treatment increases for both COPD and comorbidities should be considered.
