Study Reveals High Rates of Orthostatic Intolerance in Lung Cancer Surgery Patients, Suggests Focus on Pain Management

The study, published in BMC Surgery, further revealed that being female and experiencing high levels of pain while sitting were identified as independent risk factors for orthostatic intolerance.

"This indicates that special attention should be directed towards these at-risk patients. By optimizing pain management for these groups, we may reduce the likelihood of developing orthostatic intolerance, promoting early mobilization and enhancing postoperative rehabilitation," the researchers wrote.

Thoracoscopic lung resection is a minimally invasive surgical technique often employed in lung cancer treatment. Early postoperative mobilization is crucial for improving recovery, but it can be impeded by orthostatic intolerance. However, research on this condition following thoracoscopic lung resection is limited. To fill this knowledge gap, Wenfeng Tang, Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China, and colleagues aimed to investigate the prevalence and variables contributing to orthostatic intolerance on the first day following thoracoscopic lung cancer resection.

For this purpose, the researchers carried out a prospective observational study from February 1 to May 5, 2023, at the First Affiliated Hospital of Chongqing Medical University. The study enrolled 215 patients who underwent thoracoscopic lung resection. Researchers collected data on their general demographics, disease characteristics, treatment details, and instances of orthostatic intolerance.

The study led to the following findings:

• 29.77% of patients demonstrated orthostatic intolerance during early mobilization, and 43.75% failed to walk.
• The prevalence of nausea, dizziness, and impaired vision was 60.94%, 92.19%, and 25.00%, respectively, and no patient experienced syncope.
• The factors shown to be independently linked with orthostatic intolerance were being female (OR = 2.98) and high pain level during sitting (OR = 2.69).
• Individuals with orthostatic intolerance had a longer postoperative hospital stay with a mean of 5.42 days against 4.25 days.

In conclusion, orthostatic intolerance was frequently observed during early mobilization after thoracoscopic lung cancer resection. Common symptoms included dizziness, nausea, and impaired vision, which hindered patients' ability to mobilize and extended their postoperative hospitalization. The study identified two independent risk factors for OI: female sex and elevated pain levels while sitting.

This study faced several limitations, including the inability to schedule mobilization evaluations consistently for all participants. While postoperative OI typically improves over time, our analysis found no significant differences between OI and control groups. Also, the researchers did not assess postoperative inflammation or quantify perioperative intravenous fluid, which may affect OI.

Reference:

Yi, H., Tang, W., Shen, Y. et al. Orthostatic intolerance during early mobilization following thoracoscopic lung resection: a prospective observational study. BMC Surg 24, 265 (2024). https://doi.org/10.1186/s12893-024-02556-3