Application effect of fast track surgery-clinical nursing pathway combined with comfort care in the perioperative period of patients undergoing thoracoscopic radical resection of lung cancer

Application effect of fast track surgery-clinical nursing pathway combined with comfort care in the perioperative period of patients undergoing thoracoscopic radical resection of lung cancer | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Application effect of fast track surgery-clinical nursing pathway combined with comfort care in the perioperative period of patients undergoing thoracoscopic radical resection of lung cancer Qing Gao, Yihui Xing, Rongying Wang, Kexin Xu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6417828/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective This paper aimed to compare the application effect of fast track surgery-clinical nursing pathway (FTS-CNP) combined with comfort care in the perioperative period of patients undergoing thoracoscopic radical resection of lung cancer. Methods Eighty-six lung cancer patients who underwent thoracoscopic radical resection of lung cancer were retrospectively gathered and assigned into the routine group and the combined group following the different nursing methods (n = 43 cases). The two groups adopted conventional nursing care, FTS-CNP combined with comfort care in the perioperative period, respectively. The postoperative rehabilitation indicators (the time of voluntary cough, out-of-bed activity, urinary catheter removal, chest tube removal, and hospitalization) and the Visual Analog Scale (VAS) scores at 6 h, 1 d, 3 d and 7 d after surgery were compared between the two groups. Self-Assessment Scale for Anxiety (SAS), Self-Assessment Scale for Depression (SDS), General Comfort Questionnaire (GCQ), and 6-min walking distance (6-MWD) were assessed preoperatively and 1 week postoperatively in both groups. Lung function [forced vital capacity (FVC) and forced expiratory volume in one second (FEV1)] was tested in both groups before and 1 month after surgery. Postoperative complications and satisfaction with care were counted in both groups. Results The postoperative time for voluntary coughing, getting out of bed, urinary catheter removal, chest tube removal and hospitalization in the combined group was shorter versus the routine group. VAS scores at 6 h, 1 d, 3 d, and 7 d postoperatively were lower in the combined group than in the routine group. Lower SAS and SDS scores were observed in both groups at 1 week postoperatively, and they were lower in the combined group than in the routine group. GCQ scores increased and 6-MWD decreased in both groups at 1 week postoperatively, and both were higher in the combined group in contrast to the routine group. FVC and FEV1 were reduced in both groups 1 month after surgery, but they were higher in the combined group than in the routine group. Postoperative complications in the combined group were less, and satisfaction with care was higher than in the routine group. Conclusion FTS-CNP combined with comfort care applied in the perioperative period of patients undergoing thoracoscopic radical resection of lung cancer helps to accelerate postoperative rehabilitation, reduces postoperative pain, relieves negative emotions, increases the patients’ postoperative comfort, and improves exercise tolerance and lung function. Thoracoscopic radical resection of lung cancer Fast track surgery Clinical nursing pathway Comfort care Perioperative period Application effect Introduction Lung cancer remains a outstanding global health issue, leading to a large number of diseases and mortality rates. It is widely recognized a common and deadly cancer worldwide [ 1 ]. Over the years, its incidence rate has increased markedly. The urgency of effective management of this malignancy cannot be overemphasized, because delays in diagnosis and therapy may lead to adverse consequences, consisting of serious incidence rate and mortality [ 2 ]. Surgical procedures, especially thoracoscopic radical resection, are now regarded to the fundamental method for the treatment of early and locally advanced lung cancer [ 3 ]. Thoracoscopic radical resection is an improved form of video-assisted thoracoscopic surgery (VATS) that significantly diminishes invasiveness, strengthens surgical precision, and minimizes tissue trauma, as compared to open thoracotomy [ 4 ]. This can reduce postoperative pain, shorten hospitalization time, and accelerate recovery speed. Its development has made it the first choice for lung cancer surgery, supplying excellent accuracy and patient outcomes [ 5 ]. However, even with advances in surgical procedures and postoperative care, there is still a risk of complications associated with thoracoscopic radical surgery [ 6 ]. The clinical nursing pathway (CNP), as a standard comprehensive nursing plan designed specifically for nursing and healthcare professionals, provides patients with daily care plans and multidisciplinary services [ 7 ]. CNP has improved in terms of time, cost, and quality, leading to better nursing coordination [ 8 ]. In China, CNPs are basically utilized in the early treatment stage of surgical diseases. This treatment model has been increasingly applied in pediatric diseases, medical diseases, infectious diseases, and mental illnesses over the past few years [ 9 ]. The enhanced recovery after surgery (ERAS) concept, also called “fast track”, was first introduced in 1997. Fast track surgery (FTS) is an evidence-based intervention for multimodal and coordinated CNP [ 10 ]. FTS combines multiple novel technologies and theories for preoperative, perioperative, as well as postoperative care of patients. These methods consist of anesthesia, optimal pain control, nutritional monitoring, and surgical techniques, which reduces stress response, incidence rate and mortality, thus greatly decreasing the time required for complete recovery [ 11 ]. FTS-CNP enhances patients’ satisfaction, decreases costs, as well as uses medical resources in the most valid way [ 11 ]. Nevertheless, the difficulties in implementing this method widely consist of the diversity of hospital environments, insufficient staffing in wards, insufficient postoperative mobilization of patients, utilization of opioid-based pain relief programs, lack of clear discharge criteria, as well as poor preoperative patient information [ 12 ]. Comfort care is a new nursing model that advocates offering safe and comfortable care for patients, aiming to attain the most relaxed state of mind and body, and minimize discomfort as much as possible [ 13 ]. Comfort care has been suggested to effectively mitigate vomiting reactions in lung cancer patients post-chemotherapy, and has a remarkable effect on improving their quality of life, psychological state, as well as treatment effectiveness [ 14 ]. Therefore, this paper aimed to compare the application effect of FTS-CNP combined with comfort care in the perioperative period of patients undergoing thoracoscopic radical resection of lung cancer. Materials and methods Ethical approval The study was ratified by the Ethic Committee of Jiangsu Cancer Hospital (Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital) (approval number: 20200123). Written informed consent was got from all participants. This study complied with the Declaration of Helsinki. General information Eighty-six cases of lung cancer patients who underwent thoracoscopic radical resection of lung cancer in Jiangsu Cancer Hospital (Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital) from May 2020 to November 2021 were retrospectively gathered and assigned into the routine group and the combined group following the different nursing methods (n = 43 cases). There presented no differences in baseline indicators between the two groups ( P > 0.05), and the balance between the groups was comparable (Table 1). Inclusion criteria ① Patients met the diagnostic criteria for stage I-III of primary lung cancer [ 15 ] and the indications for thoracoscopic radical resection of lung cancer [ 16 ]; ② 18-75 years old; ③ ASA grade I-II before surgery; ④ CT showed no hilar and mediastinal lymph node metastasis and no invasion of adjacent structures; ⑤ first surgery without receiving radiotherapy or chemotherapy; ⑥ no history of psychiatric illness or cognitive impairment; ⑦ patients understood and cooperated with the study requirements and signed informed consent; ⑧ postoperative survival was expected to be ≥ 3 months. Exclusion criteria ① Patients with imaging diagnosis of distant metastasis of the tumor; ② history of concomitant other malignant tumors; ③ heart, liver, kidney and other functional failure; ④ history of previous thoracoscopic surgery or contraindications to surgery; ⑤ the presence of severe infection or immunosuppressed state; ⑥ preoperative angina pectoris, arrhythmia and other cardiac diseases; ⑦ history of previous drug abuse or addiction; ⑧ patients whose factors resulted in unwillingness or inability to follow the care pathway, or patients who needed to be terminated from the study by transferring to another department or hospital. Methods Patients in the routine group took routine care in the perioperative period. The contents mainly include (1) preoperative: ① routine admission education of thoracic surgery; ② routine admission assessment; ③ preoperative education: focusing on the medical advice education, while explaining to the patients and their families the purpose and process of rapid rehabilitation, the necessity of early intake of water and activities, and informing the patients of early postoperative activities; ④ preoperative preparation: informing patients of the pulmonary function exercise, fasting for 12 h before the operation, no purified fluids for 8 h before the operation, and the skin of the operating area is prepared for 1 d before the operation; ⑤ record: the nurse in charge of improving the patient’s various indicators of nursing paperwork records, measurement and inclusion. (2) Postoperative: ① routine care: condition observation, cardiac monitoring, line care, and fluid management; ② doctor’s room visit; ③ activities: informing the patient of early activities, according to the patient’s wishes, to assist in getting out of bed; ④ infusion therapy: intravenous infusion of 250 ml glucose and converted sugar electrolyte (2 times/day), 500 ml amino acid injection (1 time/day), 250 ml medium/long-chain fat lactic (1 time/day), etc., which is adjusted according to the patient’s eating situation and nutritional status; ⑤ diet care: informing the patient a small amount of water, according to the patient’s intestinal function recovery, the doctor will decide the exact time of the diet; ⑥ pain care: no uniform requirements for pain assessment and analgesic measures; ⑦ understanding of the patient’s pulmonary discomfort symptoms, complications occurring in the precursor symptoms; ⑧ postoperative records: filling out the form according to the FTS Patient End-of-Bed Surgical Record Form criteria; ⑨ discharge instructions. Patients in the combined group took FTS-CNP combined comfort care in the perioperative period. The contents mainly include (1) preoperative: ① routine admission education in thoracic surgery; ② admission assessment: including routine admission assessment as well as NRS-2002 nutritional screening and Caprini thrombosis risk assessment, nutritional support for those with NRS-2002 ≥ 3 points, and early adoption of appropriate preventive measures such as activity, compression stockings, sequential compression or drug intervention for those with Caprini ≥ 1 points; ③ preoperative education: FTS education: issuing education manuals, pain and nutrition manuals in advance, so that patients have sufficient time to understand and prepare for the problem, and then the nurse in charge of the proposed surgery patients for one-on-one FTS health education, introduce the main purpose of FTS and the process of carrying out, answer the questions of the patients to obtain understanding and cooperation, change the misconceptions about pain, and guidance on the perioperative diet. CNP education: issuing the patient version of the clinical care pathway table, helping patients understand the content of the clinical care pathway, and obtain patients’ cooperation; ④ preoperative preparation: preoperative guidance and supervision of patients to perform pulmonary function exercises, such as abdominal respiration by blowing up the balloon (10-20 min/times, 3-5 times/d), (10 min/times, 4 times/d), fasting for 6 h before the operation, banning clear fluids for 4 h, and preparation of the skin of the operating area for 1 d before the operation; ⑤ records: the same as in the routine group. (2) Postoperative: ① routine care: the same as the routine group; ② multidisciplinary collaboration and integration of surgical patients room visits, timely understanding of the next step in the focus of nursing care, and the development of the condition of the recovery situation; ③ activities: after awake from anesthesia, patients are instructed on ankle pump exercise (5 min/time, 5-8 times/day) and awake for 12 h; healthcare and patients work together to formulate a personalized activity plan for the postoperative period and assist the patients to go from sitting up to standing up slowly at the bedside, with a target activity of 1-2 h on the 1 st postoperative day, a target activity of 4-6 h on the 2 nd postoperative day, and free movement on the 3 rd postoperative day, which is not fatigue-inducing; ④ infusion therapy: same as the routine group; ⑤ dietary care: patients are instructed to rinse their mouths after waking up from anesthesia; after waking up, if the patients do not have abdominal distension and discomfort, they can follow the doctor’s instructions to take water and lotus root powder in small quantities, etc.; if the patients do not have any discomfort on the first postoperative day, they can be given a normal diet; ⑥ pain care: Visual Analog Scale (VAS) assessment of pain is carried out following the department’s standard process of pain after the operation; if the VAS is < 4 points, the patients are given treatments to alleviate the pain, such as distraction and relaxation. If the VAS score is ≥ 4, notify the doctor for drug treatment; ⑦ comfort care: the patients are instructed on the correct way of breathing, and at the same time, to conduct chest wall physiotherapy and chest wall percussion, and give nebulized inhalation every 6 h to improve their shortness of breath, chest tightness, coughing, and other uncomfortable symptoms. The humidity and temperature of the room should be maintained in a range that is suitable for the patient. The light in the room should be soft to help the patient go to sleep, and sleeping pills should be given to the patient if necessary to solve his insomnia problem; ⑧ psychological care: nursing staff should take the initiative to communicate with the patient to understand the patient’s psychological state, its pessimism, anxiety, fear and other adverse emotions for channeling interventions, to establish a good nurse-patient relationship in order to improve the effectiveness of clinical care. The family members of the patients should be instructed in their words and deeds to reduce the adverse stimuli to the patients and ensure the emotional stability of the patients; ⑨ concerned about the patients’ postoperative rehabilitation: nursing staff should instruct and supervise patients’ postoperative diet and activities, and pay attention to postoperative pulmonary discomfort, pain control, and complications; ⑩ postoperative records and discharge instructions are the same as those for the routine group. Observation indicators (1) Postoperative rehabilitation indices: the postoperative voluntary cough time, time to get out of bed, chest tube removal time, urinary catheter removal time and hospitalization time of the two groups of patients were recorded and compared. (2) Postoperative pain level: the VAS scores of the two groups of patients at 6 h, 1 d, 3 d, and 7 d postoperatively were recorded and compared, and the scoring criteria, i.e., the use of a ruler, were divided into 10 equal parts, with 0-10 representing the pain level of no pain-severe pain, respectively. (3) Negative mood: preoperative and 1 week postoperative, the scores of Self-Assessment Scale for Anxiety (SAS) and Self-Assessment Scale for Depression (SDS) of the two groups were assessed, which both contained 20 entries, of which SAS ≥ 50 points suggesting the presence of anxiety; SDS ≥ 53 points revealing the presence of depressive mood. (4) Comfort: preoperative and 1 week postoperative, the General Comfort Questionnaire (GCQ) scores of the two groups were evaluated, divided into psychological (10 entries), physiological (5 entries), environmental (7 entries), and socio-cultural (6 entries) dimensions with a total of 28 items, with 1-4 points for each item, and the higher scores suggested a higher level of comfort. (5) Exercise tolerance: preoperative and 1 week postoperative, 6-min walking distance (6-MWD) was tested in both groups, and was divided into 4 grades: grade 1 (< 300 m), grade 2 (300-374.9 m), grade 3 (375-449.5 m), and grade 4 (≥ 450 m). The achievement of grade 3-4 indicated that patients’ cardiorespiratory function was close to or had reached normal. (6) Lung function: preoperative and 1 month postoperative, the lung function tester (MasterScreen Pneumo, Jäger, Germany) was utilized to examine the forced vital capacity (FVC) and the forced expiratory volume in one second (FEV1) in both groups. The larger the FVC measurement value, the better the patients’ lung volume recovery; the larger the FEV1 measurement value, the better the patients’ respiratory muscle recovery. (7) Others: postoperative complications and nursing satisfaction in both groups were statistically counted. Complications commonly included incision infection, incision oozing, chest infection, pleural effusion, etc. Nursing satisfaction was surveyed anonymously, and the questionnaire content was designed by the department itself, containing 20 entries, with 1-5 points for each entry (1-very dissatisfied, 5-very satisfied). The total scores of 20-59, 60-84, and 85-100 corresponded to the 3 grades of dissatisfied, satisfied, and very satisfied, respectively, and the satisfaction rate = (satisfied + very satisfied)/total number of cases × 100%. Statistical analysis The statistical analysis software was SPSS 26.0. Qualitative data were described by [n (%)] and the χ2 test was utilized. All quantitative data conformed to a skewed distribution by the one-sample Kolmogorov-Smirnov test, described by M (P25, P75), and the Mann-Whitney U test was adopted. P < 0.05 was considered significant. Results Postoperative rehabilitation indicators The postoperative time for voluntary coughing, getting out of bed, urinary catheter removal, chest tube removal and hospitalization in the combined group was shorter versus the routine group ( P < 0.05) (Table 2). Postoperative pain levels VAS scores at 6 h, 1 d, 3 d, and 7 d postoperatively were lower in the combined group than in the routine group ( P 0.05); lower SAS and SDS scores were observed in both groups at 1 week postoperatively, and they were lower in the combined group than in the routine group ( P 0.05); GCQ scores increased and 6-MWD decreased in both groups at 1 week postoperatively, and both were better in the combined group in contrast to the routine group ( P 0.05); FVC and FEV1 were reduced in both groups 1 month after surgery, but they were higher in the combined group than in the routine group ( P < 0.05) (Table 6). Complications The overall rate of postoperative complications in the combined group was 4.65% (2/43) less than in the routine group 18.60% (8/43) ( P < 0.05) (Table 7). Satisfaction Satisfaction with postoperative care was higher in the combined group 95.35% (41/43) than in the routine group 79.07% (34/43) ( P < 0.05) (Table 8). Discussion Lung cancer is usually diagnosed at a later period with a poor prognosis [17]. As the preferred method for treating lung cancer, thoracoscopic radical resection not only accurately removes the lesion, but also has minimal trauma and fast recovery [18]. As clinical studies for lung cancer continue, it has been found that thoracoscopic radical resection still leads to long-term pain, affects the patient’s cough and sputum, and even results in complications such as lung infections, thereby delaying postoperative recovery [19]. Therefore, this paper aimed to compare the application effect of FTS-CNP combined with comfort care in the perioperative period of patients undergoing thoracoscopic radical resection of lung cancer. The CNP has been broadly applied in clinical settings due to its high efficiency. This model of nursing ensures that patients obtain a complete and comprehensive plan of care from the very beginning of their hospitalization, thus avoiding ineffective hospitalization days, reducing healthcare costs, and effectively shortening hospital stays [20]. The FTS-CNP is developed and implemented via a multidisciplinary team to facilitate patient care delivery and minimize costs while maximizing efficiency [21]. As previously reported, FTS can effectively accelerate patient recovery, shorten hospitalization time, alleviate patient pain, reduce hospitalization costs, along with improve patient satisfaction during the perioperative period of thoracoscopic radical resection of lung cancer [22]. Zhang et al. have stated that FTS-CNP improves the trustworthiness of patients and their families in the medical staff, which in turn improves patients’ adherence to treatment, nursing care, and rehabilitation exercises. Besides, the model shortens the patients’ preoperative fasting and water fasting time through strict preoperative dietary management, and effective postoperative analgesia facilitates the patients’ participation in early exercise after surgery, which also accelerates their recovery [9]. The above publications have demonstrated that FTS-CNP can improve the postoperative rehabilitation outcomes of patients. Traditional nursing methods mainly focus on keeping the physiological comfort of patients with lung cancer, often neglecting the multifaceted effects of chemotherapy on their comfort [23]. High-quality nursing services are able to effectively control diseases and adjust treatment outcomes. Comfort care is a comprehensive, creative, and personalized care model that enables patients to achieve a comfortable state at the physical, psychological, as well as social levels [24]. Tian et al. have studied the influence of comfort care on the quality of rehabilitation of oral surgery patients, disclosing that comfort care is able to effectively diminish complications during the rehabilitation process, which has clinical promotion value [25]. Comfort care on the basis of the Collaborative Care Model (CCM) puts forward targeted comfort care following the patient’s specific situation, which improves the quality of care and patients mental, physical, along with emotional condition in comparison to conventional care [26]. Another study has demonstrated that comfort care can alleviate symptoms in patients with functional dyspepsia, elevate gastric emptying rate, alleviate depression and anxiety, improve gastric motility, as well as promote disease recovery [27]. The above articles have unveiled that comfort care can improve the postoperative rehabilitation outcomes of patients. In our paper, we highlighted that the postoperative time for voluntary coughing, getting out of bed, urinary catheter removal, chest tube removal and hospitalization was lower in patients with FTS-CNP combined with comfort care. Meanwhile, lower VAS, SAS, and SDS scores were observed in patients with FTS-CNP combined with comfort care. In addition, better GCQ scores and 6-MWD, and higher FVC and FEV1 were found in patients with FTS-CNP combined with comfort care. Furthermore, less postoperative complications and higher satisfaction with care were witnessed in patients with FTS-CNP combined with comfort care. These research results are the innovations of our article. To conclude, this paper highlights that FTS-CNP combined with comfort care applied in the perioperative period of patients undergoing thoracoscopic radical resection of lung cancer helps to accelerate postoperative rehabilitation, reduces postoperative pain, relieves negative emotions, increases the patients’ postoperative comfort, and improves exercise tolerance and lung function. This paper underlines that the combination of FTS-CNP and comfort care is of great significance in perioperative nursing of lung cancer patients undergoing thoracoscopic radical resection, with significant effects and worthy of clinical application. Declarations Funding No funds, grants, or other support was received. Data Availability Statement The experimental data used to support the findings of this study are available from the corresponding author upon request. Conflict of interest The authors declare that they have no conflicts of interest. 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Tables Table 1 Comparison of baseline indicators between the two groups [n(%)] Indicator Combined group (n = 43) Routine group (n = 43) χ 2 /Z P Age (years) 1.267 0.531 18~50 9 (20.93) 10 (23.26) - - 51~60 14 (32.56) 18 (41.86) - - 61~70 20 (46.51) 15 (34.88) - - Gender 0.660 0.417 Male 36 (83.72) 33 (76.74) - - Female 7 (16.28) 10 (23.26) - - Education level 0.434 0.510 Junior high school and below 24 (55.81) 27 (62.79) - - High school and above 19 (44.19) 16 (37.21) - - Smoking 0.221 0.639 No 12 (27.91) 14 (32.56) - - Yes 31 (72.09) 29 (67.44) - - ASA grade 0.422 0.516 I 18 (41.86) 21 (48.84) - - II 25 (58.14) 22 (51.16) - - Tumor stage 0.764 0.682 I 15 (34.88) 12 (27.91) - - II 23 (53.49) 27 (62.79) - - III 5 (11.63) 4 (9.30) - - Surgical site 1.989 0.738 Upper lobe of the left lung 14 (32.56) 18 (41.86) - - Lower lobe of the left lung 4 (9.30) 2 (4.65) - - Upper lobe of the right lung 10 (23.26) 8 (18.60) - - Middle lobe of the right lung 6 (13.95) 4 (9.30) - - Lower lobe of the right lung 9 (20.93) 11 (25.58) - - NRS-2002 score (point) 1.00 (1.00, 2.00) 1.00 (1.00, 2.00) -0.254 0.800 Caprini score (point) 2.00 (2.00, 3.00) 2.00 (2.00, 3.00) -0.246 0.805 Note: ASA, American Society of Anesthesiologists; NRS-2002, Nutritional Risk Screening 2002 Scale; Caprini, Caprini Thrombosis Risk Assessment Scale. Table 2 Comparison of postoperative rehabilitation indicators between the two groups Indicator Combined group (n = 43) Routine group (n = 43) Z P Coughing spontaneously (h) 11.00 (6.00, 13.00) 14.00 (10.00, 18.00) -3.531 <0.001 Getting out of bed (h) 16.00 (11.00, 18.00) 19.00 (15.00, 24.00) -3.838 <0.001 Urinary catheter removal (h) 12.00 (9.00, 13.00) 14.00 (11.00, 15.00) -2.855 0.004 Chest tube removal (d) 3.00 (2.00, 3.00) 4.00 (3.00, 4.00) -4.670 <0.001 Hospitalization (d) 10.00 (8.00, 11.00) 12.00 (10.00, 13.00) -4.203 <0.001 Table 3 Comparison of postoperative pain levels between the two groups (score) Time Combined group (n = 43) Routine group (n = 43) Z P 6 h after surgery 5.00 (5.00, 6.00) 7.00 (6.00, 7.00) -5.010 <0.001 1 d after surgery 5.00 (4.00, 5.00) 6.00 (5.00, 6.00) -5.283 <0.001 3 d after surgery 3.00 (3.00, 4.00) 5.00 (4.00, 5.00) -6.754 <0.001 7 d after surgery 2.00 (1.00, 2.00) 2.00 (2.00, 2.00) -5.189 <0.001 Table 4 Comparison of negative emotions between the two groups (score) Time Combined group (n = 43) Routine group (n = 43) Z P Before surgery SAS 54.00 (50.00, 56.00) 54.00 (49.00, 55.00) -0.884 0.377 SDS 56.00 (51.00, 59.00) 56.00 (50.00, 59.00) -0.454 0.650 1 week after surgery SAS 41.00 (38.00, 42.00) a 46.00 (42.00, 49.00) a -4.767 <0.001 SDS 40.00 (36.00, 43.00) a 48.00 (42.00, 50.00) a -5.497 <0.001 Note: a P < 0.05 compared to preoperative in the same group. Table 5 Comparison of comfort and exercise tolerance between the two groups Time Combined group (n = 43) Routine group (n = 43) Z P Before surgery GCQ (point) 61.00 (55.00, 64.00) 60.00 (58.00, 65.00) -1.572 0.116 6-MWD (m) 532.00 (477.00, 563.00) 535.00 (484.00, 564.00) -0.302 0.762 1 week after surgery GCQ (point) 92.00 (88.00, 95.00) a 81.00 (77.00, 84.00) a -7.052 <0.001 6-MWD (m) 459.00 (398.00, 487.00) a 404.00 (328.00, 443.00) a -3.295 0.001 Note: a P < 0.05 compared to preoperative in the same group. Table 6 Comparison of lung function between the two groups (L) Time Combined group (n = 43) Routine group (n = 43) Z P Before surgery FVC 3.00 (2.60, 3.40) 3.10 (2.70, 3.30) -0.143 0.886 FEV1 2.70 (2.20, 2.90) 2.80 (2.10, 3.00) -0.614 0.539 1 month after surgery FVC 2.30 (1.80, 2.70) a 2.00 (1.60, 2.20) a -3.042 0.002 FEV1 1.80 (1.30, 2.10) a 1.50 (1.10, 1.80) a -2.277 0.023 Note: a P < 0.05 compared to preoperative in the same group. Table 7 Comparison of complications between the two groups [n(%)] Complications Combined group (n = 43) Routine group (n = 43) χ 2 P Incision infection 0 (0.00) 1 (2.33) - - Incision oozing 1 (2.33) 2 (4.65) - - Thoracic infection 0 (0.00) 2 (4.65) - - Pleural effusion 1 (2.33) 3 (6.98) - - Total 2 (4.65) 8 (18.60) 4.074 0.044 Table 8 Comparison of satisfaction between the two groups [n(%)] Satisfaction degree Combined group (n = 43) Routine group (n = 43) χ 2 P Dissatisfied 2 (4.65) 9 (20.93) - - Satisfied 15 (34.88) 15 (34.88) - - Very satisfied 26 (60.47) 19 (44.19) - - Satisfaction rate 41 (95.35) 34 (79.07) 5.108 0.024 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6417828","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":456258330,"identity":"6c56b202-b1c2-499a-b2a7-74b217de1be3","order_by":0,"name":"Qing Gao","email":"","orcid":"","institution":"Jiangsu Cancer Hospital (Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital)","correspondingAuthor":false,"prefix":"","firstName":"Qing","middleName":"","lastName":"Gao","suffix":""},{"id":456258333,"identity":"74ca5161-2973-45eb-ae39-ffe7d65050cf","order_by":1,"name":"Yihui Xing","email":"","orcid":"","institution":"Jiangsu Cancer Hospital (Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital)","correspondingAuthor":false,"prefix":"","firstName":"Yihui","middleName":"","lastName":"Xing","suffix":""},{"id":456258335,"identity":"693bbe63-0b93-4c90-9e8c-b1d42ce44d32","order_by":2,"name":"Rongying Wang","email":"","orcid":"","institution":"Jiangsu Cancer Hospital (Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital)","correspondingAuthor":false,"prefix":"","firstName":"Rongying","middleName":"","lastName":"Wang","suffix":""},{"id":456258337,"identity":"e028e56d-d95c-4f5e-8ed6-2271e013232a","order_by":3,"name":"Kexin Xu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA20lEQVRIie3QMQrCMBSA4VcKxSGYTVIcvMIrLg6iV6m4RvQISkEX3Vu8RI8QeVAXxQPoIAhODgGXDg7GVcTGzSH/kCz5SPIAXK4/DBVDs0KP80QpXdqR+EWGYVoMNtnSgoRTpl67lyvZplpgQbgYzS5scvJB7TQBgxZvqO8kEGM/SvFa95JVTpMORNk6riSB0Ei+D/ucUgYxHiuIediijJG8OcgzscCChKkswNziLUGCHcHdzcwXaShEgWbIovovuJXRnT2o1z8kF63Lbos3K8h74rfjLpfL5frcE/dgSTbjhWU8AAAAAElFTkSuQmCC","orcid":"","institution":"Jiangsu Cancer Hospital (Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital)","correspondingAuthor":true,"prefix":"","firstName":"Kexin","middleName":"","lastName":"Xu","suffix":""}],"badges":[],"createdAt":"2025-04-10 08:08:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6417828/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6417828/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":86229152,"identity":"27b29c37-a7d5-4ccf-9ff6-7bf60078e96c","added_by":"auto","created_at":"2025-07-08 08:32:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":830353,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6417828/v1/aa102e52-eb8f-4e9c-91b9-fd2fd3998350.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Application effect of fast track surgery-clinical nursing pathway combined with comfort care in the perioperative period of patients undergoing thoracoscopic radical resection of lung cancer","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLung cancer remains a outstanding global health issue, leading to a large number of diseases and mortality rates. It is widely recognized a common and deadly cancer worldwide [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Over the years, its incidence rate has increased markedly. The urgency of effective management of this malignancy cannot be overemphasized, because delays in diagnosis and therapy may lead to adverse consequences, consisting of serious incidence rate and mortality [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Surgical procedures, especially thoracoscopic radical resection, are now regarded to the fundamental method for the treatment of early and locally advanced lung cancer [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Thoracoscopic radical resection is an improved form of video-assisted thoracoscopic surgery (VATS) that significantly diminishes invasiveness, strengthens surgical precision, and minimizes tissue trauma, as compared to open thoracotomy [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This can reduce postoperative pain, shorten hospitalization time, and accelerate recovery speed. Its development has made it the first choice for lung cancer surgery, supplying excellent accuracy and patient outcomes [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, even with advances in surgical procedures and postoperative care, there is still a risk of complications associated with thoracoscopic radical surgery [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe clinical nursing pathway (CNP), as a standard comprehensive nursing plan designed specifically for nursing and healthcare professionals, provides patients with daily care plans and multidisciplinary services [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. CNP has improved in terms of time, cost, and quality, leading to better nursing coordination [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In China, CNPs are basically utilized in the early treatment stage of surgical diseases. This treatment model has been increasingly applied in pediatric diseases, medical diseases, infectious diseases, and mental illnesses over the past few years [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The enhanced recovery after surgery (ERAS) concept, also called \u0026ldquo;fast track\u0026rdquo;, was first introduced in 1997. Fast track surgery (FTS) is an evidence-based intervention for multimodal and coordinated CNP [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. FTS combines multiple novel technologies and theories for preoperative, perioperative, as well as postoperative care of patients. These methods consist of anesthesia, optimal pain control, nutritional monitoring, and surgical techniques, which reduces stress response, incidence rate and mortality, thus greatly decreasing the time required for complete recovery [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. FTS-CNP enhances patients\u0026rsquo; satisfaction, decreases costs, as well as uses medical resources in the most valid way [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Nevertheless, the difficulties in implementing this method widely consist of the diversity of hospital environments, insufficient staffing in wards, insufficient postoperative mobilization of patients, utilization of opioid-based pain relief programs, lack of clear discharge criteria, as well as poor preoperative patient information [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Comfort care is a new nursing model that advocates offering safe and comfortable care for patients, aiming to attain the most relaxed state of mind and body, and minimize discomfort as much as possible [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Comfort care has been suggested to effectively mitigate vomiting reactions in lung cancer patients post-chemotherapy, and has a remarkable effect on improving their quality of life, psychological state, as well as treatment effectiveness [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Therefore, this paper aimed to compare the application effect of FTS-CNP combined with comfort care in the perioperative period of patients undergoing thoracoscopic radical resection of lung cancer.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was ratified by the Ethic Committee of Jiangsu Cancer Hospital (Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital) (approval number: 20200123). Written informed consent was got from all participants. This study complied with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGeneral information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEighty-six cases of lung cancer patients who underwent thoracoscopic radical resection of lung cancer in Jiangsu Cancer Hospital (Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital) from May 2020 to November 2021 were retrospectively gathered and assigned into the routine group and the combined group following the different nursing methods (n = 43 cases). There presented no differences in baseline indicators between the two groups (\u003cem\u003eP\u003c/em\u003e \u0026gt; 0.05), and the balance between the groups was comparable (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e① Patients met the diagnostic criteria for stage I-III of primary lung cancer [\u003ca href=\"#_ENREF_15\" title=\", 2019 #16\"\u003e15\u003c/a\u003e]\u0026nbsp;and the indications for thoracoscopic radical resection of lung cancer\u0026nbsp;[\u003ca href=\"#_ENREF_16\" title=\"Brunelli, 2009 #17\"\u003e16\u003c/a\u003e]; ② 18-75 years old; ③ ASA grade I-II before surgery; ④ CT showed no hilar and mediastinal lymph node metastasis and no invasion of adjacent structures; ⑤ first surgery without receiving radiotherapy or chemotherapy; ⑥ no history of psychiatric illness or cognitive impairment; ⑦ patients understood and cooperated with the study requirements and signed informed consent; ⑧ postoperative survival was expected to be \u0026ge; 3 months.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e① Patients with imaging diagnosis of distant metastasis of the tumor; ② history of concomitant other malignant tumors; ③ heart, liver, kidney and other functional failure; ④ history of previous thoracoscopic surgery or contraindications to surgery; ⑤ the presence of severe infection or immunosuppressed state; ⑥ preoperative angina pectoris, arrhythmia and other cardiac diseases; ⑦ history of previous drug abuse or addiction; ⑧ patients whose factors resulted in unwillingness or inability to follow the care pathway, or patients who needed to be terminated from the study by transferring to another department or hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients in the routine group took routine care in the perioperative period. The contents mainly include (1) preoperative: ① routine admission education of thoracic surgery; ② routine admission assessment; ③ preoperative education: focusing on the medical advice education, while explaining to the patients and their families the purpose and process of rapid rehabilitation, the necessity of early intake of water and activities, and informing the patients of early postoperative activities; ④ preoperative preparation: informing patients of the pulmonary function exercise, fasting for 12 h before the operation, no purified fluids for 8 h before the operation, and the skin of the operating area is prepared for 1 d before the operation; ⑤ record: the nurse in charge of improving the patient\u0026rsquo;s various indicators of nursing paperwork records, measurement and inclusion. (2) Postoperative: ① routine care: condition observation, cardiac monitoring, line care, and fluid management; ② doctor\u0026rsquo;s room visit; ③ activities: informing the patient of early activities, according to the patient\u0026rsquo;s wishes, to assist in getting out of bed; ④ infusion therapy: intravenous infusion of 250 ml glucose and converted sugar electrolyte (2 times/day), 500 ml amino acid injection (1 time/day), 250 ml medium/long-chain fat lactic (1 time/day), etc., which is adjusted according to the patient\u0026rsquo;s eating situation and nutritional status; ⑤ diet care: informing the patient a small amount of water, according to the patient\u0026rsquo;s intestinal function recovery, the doctor will decide the exact time of the diet; ⑥ pain care: no uniform requirements for pain assessment and analgesic measures; ⑦ understanding of the patient\u0026rsquo;s pulmonary discomfort symptoms, complications occurring in the precursor symptoms; ⑧ postoperative records: filling out the form according to the FTS Patient End-of-Bed Surgical Record Form criteria; ⑨ discharge instructions.\u003c/p\u003e\n\u003cp\u003ePatients in the combined group took FTS-CNP combined comfort care in the perioperative period. The contents mainly include (1) preoperative: ① routine admission education in thoracic surgery; ② admission assessment: including routine admission assessment as well as NRS-2002 nutritional screening and Caprini thrombosis risk assessment, nutritional support for those with NRS-2002 \u0026ge; 3 points, and early adoption of appropriate preventive measures such as activity, compression stockings, sequential compression or drug intervention for those with Caprini \u0026ge; 1 points; ③ preoperative education: FTS education: issuing education manuals, pain and nutrition manuals in advance, so that patients have sufficient time to understand and prepare for the problem, and then the nurse in charge of the proposed surgery patients for one-on-one FTS health education, introduce the main purpose of FTS and the process of carrying out, answer the questions of the patients to obtain understanding and cooperation, change the misconceptions about pain, and guidance on the perioperative diet. CNP education: issuing the patient version of the clinical care pathway table, helping patients understand the content of the clinical care pathway, and obtain patients\u0026rsquo; cooperation; ④ preoperative preparation: preoperative guidance and supervision of patients to perform pulmonary function exercises, such as abdominal respiration by blowing up the balloon (10-20 min/times, 3-5 times/d), (10 min/times, 4 times/d), fasting for 6 h before the operation, banning clear fluids for 4 h, and preparation of the skin of the operating area for 1 d before the operation; ⑤ records: the same as in the routine group. (2) Postoperative: ① routine care: the same as the routine group; ② multidisciplinary collaboration and integration of surgical patients room visits, timely understanding of the next step in the focus of nursing care, and the development of the condition of the recovery situation; ③ activities: after awake from anesthesia, patients are instructed on ankle pump exercise (5 min/time, 5-8 times/day) and awake for 12 h; healthcare and patients work together to formulate a personalized activity plan for the postoperative period and assist the patients to go from sitting up to standing up slowly at the bedside, with a target activity of 1-2 h on the 1\u003csup\u003est\u003c/sup\u003e postoperative day, a target activity of 4-6 h on the 2\u003csup\u003end\u003c/sup\u003e postoperative day, and free movement on the 3\u003csup\u003erd\u003c/sup\u003e postoperative day, which is not fatigue-inducing; ④ infusion therapy: same as the routine group; ⑤ dietary care: patients are instructed to rinse their mouths after waking up from anesthesia; after waking up, if the patients do not have abdominal distension and discomfort, they can follow the doctor\u0026rsquo;s instructions to take water and lotus root powder in small quantities, etc.; if the patients do not have any discomfort on the first postoperative day, they can be given a normal diet; ⑥ pain care: Visual Analog Scale (VAS) assessment of pain is carried out following the department\u0026rsquo;s standard process of pain after the operation; if the VAS is \u0026lt; 4 points, the patients are given treatments to alleviate the pain, such as distraction and relaxation. If the VAS score is \u0026ge; 4, notify the doctor for drug treatment; ⑦ comfort care: the patients are instructed on the correct way of breathing, and at the same time, to conduct chest wall physiotherapy and chest wall percussion, and give nebulized inhalation every 6 h to improve their shortness of breath, chest tightness, coughing, and other uncomfortable symptoms. The humidity and temperature of the room should be maintained in a range that is suitable for the patient. The light in the room should be soft to help the patient go to sleep, and sleeping pills should be given to the patient if necessary to solve his insomnia problem;\u0026nbsp;⑧\u0026nbsp;psychological care: nursing staff should take the initiative to communicate with the patient to understand the patient\u0026rsquo;s psychological state, its pessimism, anxiety, fear and other adverse emotions for channeling interventions, to establish a good nurse-patient relationship in order to improve the effectiveness of clinical care. The family members of the patients should be instructed in their words and deeds to reduce the adverse stimuli to the patients and ensure the emotional stability of the patients;\u0026nbsp;⑨\u0026nbsp;concerned about the patients\u0026rsquo; postoperative rehabilitation: nursing staff should instruct and supervise patients\u0026rsquo; postoperative diet and activities, and pay attention to postoperative pulmonary discomfort, pain control, and complications;\u0026nbsp;⑩\u0026nbsp;postoperative records and discharge instructions are the same as those for the routine group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObservation indicators\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e(1) Postoperative rehabilitation indices: the postoperative voluntary cough time, time to get out of bed, chest tube removal time, urinary catheter removal time and hospitalization time of the two groups of patients were recorded and compared.\u003c/p\u003e\n\u003cp\u003e(2) Postoperative pain level: the VAS scores of the two groups of patients at 6 h, 1 d, 3 d, and 7 d postoperatively were recorded and compared, and the scoring criteria, i.e., the use of a ruler, were divided into 10 equal parts, with 0-10 representing the pain level of no pain-severe pain, respectively.\u003c/p\u003e\n\u003cp\u003e(3) Negative mood: preoperative and 1 week postoperative, the scores of Self-Assessment Scale for Anxiety (SAS) and Self-Assessment Scale for Depression (SDS) of the two groups were assessed, which both contained 20 entries, of which SAS \u0026ge; 50 points suggesting the presence of anxiety; SDS \u0026ge; 53 points revealing the presence of depressive mood.\u003c/p\u003e\n\u003cp\u003e(4) Comfort: preoperative and 1 week postoperative, the General Comfort Questionnaire (GCQ) scores of the two groups were evaluated, divided into psychological (10 entries), physiological (5 entries), environmental (7 entries), and socio-cultural (6 entries) dimensions with a total of 28 items, with 1-4 points for each item, and the higher scores suggested a higher level of comfort.\u003c/p\u003e\n\u003cp\u003e(5) Exercise tolerance: preoperative and 1 week postoperative, 6-min walking distance (6-MWD) was tested in both groups, and was divided into 4 grades: grade 1 (\u0026lt; 300 m), grade 2 (300-374.9 m), grade 3 (375-449.5 m), and grade 4 (\u0026ge; 450 m). The achievement of grade 3-4 indicated that patients\u0026rsquo; cardiorespiratory function was close to or had reached normal.\u003c/p\u003e\n\u003cp\u003e(6) Lung function: preoperative and 1 month postoperative, the lung function tester (MasterScreen Pneumo, J\u0026auml;ger, Germany) was utilized to examine the forced vital capacity (FVC) and the forced expiratory volume in one second (FEV1) in both groups. The larger the FVC measurement value, the better the patients\u0026rsquo; lung volume recovery; the larger the FEV1 measurement value, the better the patients\u0026rsquo; respiratory muscle recovery.\u003c/p\u003e\n\u003cp\u003e(7) Others: postoperative complications and nursing satisfaction in both groups were statistically counted. Complications commonly included incision infection, incision oozing, chest infection, pleural effusion, etc. Nursing satisfaction was surveyed anonymously, and the questionnaire content was designed by the department itself, containing 20 entries, with 1-5 points for each entry (1-very dissatisfied, 5-very satisfied). The total scores of 20-59, 60-84, and 85-100 corresponded to the 3 grades of dissatisfied, satisfied, and very satisfied, respectively, and the satisfaction rate = (satisfied + very satisfied)/total number of cases \u0026times; 100%.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe statistical analysis software was SPSS 26.0. Qualitative data were described by [n (%)] and the \u0026chi;2 test was utilized. All quantitative data conformed to a skewed distribution by the one-sample Kolmogorov-Smirnov test, described by M (P25, P75), and the Mann-Whitney U test was adopted. \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt; 0.05 was considered significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003ePostoperative rehabilitation indicators\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe postoperative time for voluntary coughing, getting out of bed, urinary catheter removal, chest tube removal and hospitalization in the combined group was shorter versus the routine group (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05) (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePostoperative pain levels\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVAS scores at 6 h, 1 d, 3 d, and 7 d postoperatively were lower in the combined group than in the routine group (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05) (Table 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNegative emotions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe differences in preoperative SAS and SDS scores between the two groups were not significant (\u003cem\u003eP\u003c/em\u003e \u0026gt; 0.05); lower SAS and SDS scores were observed in both groups at 1 week postoperatively, and they were lower in the combined group than in the routine group (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05) (Table 4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComfort and exercise tolerance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe differences in preoperative GCQ scores and 6-MWD showed no differences between the two groups (\u003cem\u003eP\u003c/em\u003e \u0026gt; 0.05); GCQ scores increased and 6-MWD decreased in both groups at 1 week postoperatively, and both were better in the combined group in contrast to the routine group (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05) (Table 5).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLung function\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe differences in preoperative FVC and FEV1 between the two groups were insignificant (\u003cem\u003eP\u003c/em\u003e \u0026gt; 0.05); FVC and FEV1 were reduced in both groups 1 month after surgery, but they were higher in the combined group than in the routine group (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05) (Table 6).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComplications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe overall rate of postoperative complications in the combined group was 4.65% (2/43) less than in the routine group 18.60% (8/43) (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05) (Table 7).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSatisfaction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSatisfaction with postoperative care was higher in the combined group 95.35% (41/43) than in the routine group 79.07% (34/43) (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05) (Table 8).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eLung cancer is usually diagnosed at a later period with a poor prognosis [17]. As the preferred method for treating lung cancer, thoracoscopic radical resection not only accurately removes the lesion, but also has minimal trauma and fast recovery [18]. As clinical studies for lung cancer continue, it has been found that thoracoscopic radical resection still leads to long-term pain, affects the patient\u0026rsquo;s cough and sputum, and even results in complications such as lung infections, thereby delaying postoperative recovery [19]. Therefore, this paper aimed to compare the application effect of FTS-CNP combined with comfort care in the perioperative period of patients undergoing thoracoscopic radical resection of lung cancer.\u003c/p\u003e\n\u003cp\u003eThe CNP has been broadly applied in clinical settings due to its high efficiency. This model of nursing ensures that patients obtain a complete and comprehensive plan of care from the very beginning of their hospitalization, thus avoiding ineffective hospitalization days, reducing healthcare costs, and effectively shortening hospital stays [20]. The FTS-CNP is developed and implemented via a multidisciplinary team to facilitate patient care delivery and minimize costs while maximizing efficiency [21]. As previously reported, FTS can effectively accelerate patient recovery, shorten hospitalization time, alleviate patient pain, reduce hospitalization costs, along with improve patient satisfaction during the perioperative period of thoracoscopic radical resection of lung cancer [22]. Zhang et al. have stated that FTS-CNP improves the trustworthiness of patients and their families in the medical staff, which in turn improves patients\u0026rsquo; adherence to treatment, nursing care, and rehabilitation exercises. Besides, the model shortens the patients\u0026rsquo; preoperative fasting and water fasting time through strict preoperative dietary management, and effective postoperative analgesia facilitates the patients\u0026rsquo; participation in early exercise after surgery, which also accelerates their recovery [9]. The above publications have demonstrated that FTS-CNP can improve the postoperative rehabilitation outcomes of patients.\u003c/p\u003e\n\u003cp\u003eTraditional nursing methods mainly focus on keeping the physiological comfort of patients with lung cancer, often neglecting the multifaceted effects of chemotherapy on their comfort [23]. High-quality nursing services are able to effectively control diseases and adjust treatment outcomes. Comfort care is a comprehensive, creative, and personalized care model that enables patients to achieve a comfortable state at the physical, psychological, as well as social levels [24]. Tian et al. have studied the influence of comfort care on the quality of rehabilitation of oral surgery patients, disclosing that comfort care is able to effectively diminish complications during the rehabilitation process, which has clinical promotion value [25]. Comfort care on the basis of the Collaborative Care Model (CCM) puts forward targeted comfort care following the patient\u0026rsquo;s specific situation, which improves the quality of care and patients mental, physical, along with emotional condition in comparison to conventional care [26]. Another study has demonstrated that comfort care can alleviate symptoms in patients with functional dyspepsia, elevate gastric emptying rate, alleviate depression and anxiety, improve gastric motility, as well as promote disease recovery [27]. The above articles have unveiled that comfort care can improve the postoperative rehabilitation outcomes of patients.\u003c/p\u003e\n\u003cp\u003eIn our paper, we highlighted that the postoperative time for voluntary coughing, getting out of bed, urinary catheter removal, chest tube removal and hospitalization was lower in patients with FTS-CNP combined with comfort care. Meanwhile, lower VAS, SAS, and SDS scores were observed in patients with FTS-CNP combined with comfort care. In addition, better GCQ scores and 6-MWD, and higher FVC and FEV1 were found in patients with FTS-CNP combined with comfort care. Furthermore, less postoperative complications and higher satisfaction with care were witnessed in patients with FTS-CNP combined with comfort care. These research results are the innovations of our article.\u003c/p\u003e\n\u003cp\u003eTo conclude, this paper highlights that FTS-CNP combined with comfort care applied in the perioperative period of patients undergoing thoracoscopic radical resection of lung cancer helps to accelerate postoperative rehabilitation, reduces postoperative pain, relieves negative emotions, increases the patients\u0026rsquo; postoperative comfort, and improves exercise tolerance and lung function. This paper underlines that the combination of FTS-CNP and comfort care is of great significance in perioperative nursing of lung cancer patients undergoing thoracoscopic radical resection, with significant effects and worthy of clinical application.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funds, grants, or other support was received.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe experimental data used to support the findings of this study are available from the corresponding author upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBade, B.C. and C.S. 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Gayle, et al., \u003cem\u003eEnhanced recovery pathways in orthopedic surgery.\u003c/em\u003e J Anaesthesiol Clin Pharmacol, 2019. \u003cstrong\u003e35\u003c/strong\u003e(Suppl 1): p. S35-S39.\u003c/li\u003e\n\u003cli\u003eJiang, K., L. Cheng, J.J. Wang, J.S. Li, and J. Nie, \u003cem\u003eFast track clinical pathway implications in esophagogastrectomy.\u003c/em\u003e World J Gastroenterol, 2009. \u003cstrong\u003e15\u003c/strong\u003e(4): p. 496-501.\u003c/li\u003e\n\u003cli\u003eHusted, H., T.H. Lunn, A. Troelsen, L. Gaarn-Larsen, B.B. Kristensen, and H. Kehlet, \u003cem\u003eWhy still in hospital after fast-track hip and knee arthroplasty?\u003c/em\u003e Acta Orthop, 2011. \u003cstrong\u003e82\u003c/strong\u003e(6): p. 679-84.\u003c/li\u003e\n\u003cli\u003eAttai, D.J., M.S. Katz, E. Streja, J.T. Hsiung, M.V. 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Varela, et al., \u003cem\u003eERS/ESTS clinical guidelines on fitness for radical therapy in lung cancer patients (surgery and chemo-radiotherapy).\u003c/em\u003e Eur Respir J, 2009. \u003cstrong\u003e34\u003c/strong\u003e(1): p. 17-41.\u003c/li\u003e\n\u003cli\u003eLi, M.Y., L.Z. Liu, and M. Dong, \u003cem\u003eProgress on pivotal role and application of exosome in lung cancer carcinogenesis, diagnosis, therapy and prognosis.\u003c/em\u003e Mol Cancer, 2021. \u003cstrong\u003e20\u003c/strong\u003e(1): p. 22.\u003c/li\u003e\n\u003cli\u003eIwata, S., A. Hagiwara, and Y. Harima, \u003cem\u003eThoracoscopic radical surgery for a morbidly obese patient with early lung cancer after laparoscopic sleeve gastrectomy: a case report.\u003c/em\u003e Surg Case Rep, 2020. \u003cstrong\u003e6\u003c/strong\u003e(1): p. 189.\u003c/li\u003e\n\u003cli\u003eLiu, Z., R. Yang, and F. Shao, \u003cem\u003eComparison of Postoperative Pain and Recovery between Single-Port and Two-Port Thoracoscopic Lobectomy for Lung Cancer.\u003c/em\u003e Thorac Cardiovasc Surg, 2019. \u003cstrong\u003e67\u003c/strong\u003e(2): p. 142-146.\u003c/li\u003e\n\u003cli\u003eBarbieri, A., K. Vanhaecht, P. Van Herck, W. Sermeus, F. Faggiano, S. Marchisio, et al., \u003cem\u003eEffects of clinical pathways in the joint replacement: a meta-analysis.\u003c/em\u003e BMC Med, 2009. \u003cstrong\u003e7\u003c/strong\u003e: p. 32.\u003c/li\u003e\n\u003cli\u003eLin, D.X., X. Li, Q.W. Ye, F. Lin, L.L. Li, and Q.Y. Zhang, \u003cem\u003eImplementation of a fast-track clinical pathway decreases postoperative length of stay and hospital charges for liver resection.\u003c/em\u003e Cell Biochem Biophys, 2011. \u003cstrong\u003e61\u003c/strong\u003e(2): p. 413-9.\u003c/li\u003e\n\u003cli\u003eWu, Y., M. Xu, and Y. Ma, \u003cem\u003eFast-track surgery in single-hole thoracoscopic radical resection of lung cancer.\u003c/em\u003e J BUON, 2020. \u003cstrong\u003e25\u003c/strong\u003e(4): p. 1745-1752.\u003c/li\u003e\n\u003cli\u003eVranas, K.C., J.A. Lapidus, L. Ganzini, C.G. Slatore, and D.R. Sullivan, \u003cem\u003eAssociation of Palliative Care Use and Setting With Health-care Utilization and Quality of Care at the End of Life Among Patients With Advanced Lung Cancer.\u003c/em\u003e Chest, 2020. \u003cstrong\u003e158\u003c/strong\u003e(6): p. 2667-2674.\u003c/li\u003e\n\u003cli\u003eVincent, J.L., Y. Shehabi, T.S. Walsh, P.P. Pandharipande, J.A. Ball, P. Spronk, et al., \u003cem\u003eComfort and patient-centred care without excessive sedation: the eCASH concept.\u003c/em\u003e Intensive Care Med, 2016. \u003cstrong\u003e42\u003c/strong\u003e(6): p. 962-71.\u003c/li\u003e\n\u003cli\u003eTian, Y., J. Lin, and F. Gao, \u003cem\u003eThe effects of comfort care on the recovery quality of oral and maxillofacial surgery patients undergoing general anesthesia.\u003c/em\u003e Am J Transl Res, 2021. \u003cstrong\u003e13\u003c/strong\u003e(5): p. 5003-5010.\u003c/li\u003e\n\u003cli\u003eSun, C., M. Jia, H. Wu, Q. Yang, Q. Wang, L. Wang, et al., \u003cem\u003eThe effect of comfort care based on the collaborative care model on the compliance and self-care ability of patients with coronary heart disease.\u003c/em\u003e Ann Palliat Med, 2021. \u003cstrong\u003e10\u003c/strong\u003e(1): p. 501-508.\u003c/li\u003e\n\u003cli\u003eXiong, Y., H. Xing, L. Hu, J. Xie, Y. Liu, and D. Hu, \u003cem\u003eEffects of comfort care on symptoms, gastric motility, and mental state of patients with functional dyspepsia.\u003c/em\u003e Medicine (Baltimore), 2019. \u003cstrong\u003e98\u003c/strong\u003e(25): p. e16110.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e Comparison of baseline indicators between the two groups [n(%)]\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eIndicator\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003eCombined group (n = 43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003eRoutine group (n = 43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026chi;\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u003cem\u003e/Z\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e1.267\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.531\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e18~50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e9 (20.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e10 (23.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e51~60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e14 (32.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e18 (41.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e61~70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e20 (46.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e15 (34.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.660\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.417\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e36 (83.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e33 (76.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e7 (16.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e10 (23.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eEducation level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.434\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.510\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eJunior high school and below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e24 (55.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e27 (62.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eHigh school and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e19 (44.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e16 (37.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eSmoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.221\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.639\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e12 (27.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e14 (32.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e31 (72.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e29 (67.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eASA grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.422\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.516\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e18 (41.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e21 (48.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e25 (58.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e22 (51.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eTumor stage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.764\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.682\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e15 (34.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e12 (27.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e23 (53.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e27 (62.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e5 (11.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e4 (9.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eSurgical site\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e1.989\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.738\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eUpper lobe of the left lung\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e14 (32.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e18 (41.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eLower lobe of the left lung\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e4 (9.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e2 (4.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eUpper lobe of the right lung\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e10 (23.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e8 (18.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eMiddle lobe of the right lung\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e6 (13.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e4 (9.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eLower lobe of the right lung\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e9 (20.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e11 (25.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eNRS-2002 score (point)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e1.00 (1.00, 2.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e1.00 (1.00, 2.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.254\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.800\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eCaprini score (point)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e2.00 (2.00, 3.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e2.00 (2.00, 3.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.246\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.805\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: ASA, American Society of Anesthesiologists; NRS-2002, Nutritional Risk Screening 2002 Scale; Caprini, Caprini Thrombosis Risk Assessment Scale.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e Comparison of postoperative rehabilitation indicators between the two groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eIndicator\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eCombined group (n = 43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eRoutine group (n = 43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eCoughing spontaneously (h)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e11.00 (6.00, 13.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e14.00 (10.00, 18.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-3.531\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eGetting out of bed (h)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e16.00 (11.00, 18.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e19.00 (15.00, 24.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-3.838\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eUrinary catheter removal (h)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e12.00 (9.00, 13.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e14.00 (11.00, 15.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-2.855\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eChest tube removal (d)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e3.00 (2.00, 3.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e4.00 (3.00, 4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-4.670\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eHospitalization (d)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e10.00 (8.00, 11.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e12.00 (10.00, 13.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-4.203\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e Comparison of postoperative pain levels between the two groups (score)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eCombined group (n = 43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003eRoutine group (n = 43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e6 h after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e5.00 (5.00, 6.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e7.00 (6.00, 7.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-5.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e1 d after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e5.00 (4.00, 5.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e6.00 (5.00, 6.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-5.283\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e3 d after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e3.00 (3.00, 4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e5.00 (4.00, 5.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-6.754\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e7 d after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e2.00 (1.00, 2.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27px;\"\u003e\n \u003cp\u003e2.00 (2.00, 2.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-5.189\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4\u003c/strong\u003e Comparison of negative emotions between the two groups (score)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eCombined group (n = 43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003eRoutine group (n = 43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eBefore surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eSAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e54.00 (50.00, 56.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e54.00 (49.00, 55.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.884\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.377\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eSDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e56.00 (51.00, 59.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e56.00 (50.00, 59.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.454\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.650\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e1 week after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eSAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e41.00 (38.00, 42.00)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e46.00 (42.00, 49.00)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-4.767\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eSDS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e40.00 (36.00, 43.00)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28px;\"\u003e\n \u003cp\u003e48.00 (42.00, 50.00)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-5.497\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: a\u003cem\u003e\u0026nbsp;P\u003c/em\u003e \u0026lt; 0.05 compared to preoperative in the same group.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5\u003c/strong\u003e Comparison of comfort and exercise tolerance between the two groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003eCombined group (n = 43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003eRoutine group (n = 43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eBefore surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eGCQ (point)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e61.00 (55.00, 64.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e60.00 (58.00, 65.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e-1.572\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.116\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e6-MWD (m)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e532.00 (477.00, 563.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e535.00 (484.00, 564.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e-0.302\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.762\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e1 week after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003eGCQ (point)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e92.00 (88.00, 95.00)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e81.00 (77.00, 84.00)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e-7.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17px;\"\u003e\n \u003cp\u003e6-MWD (m)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e459.00 (398.00, 487.00)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30px;\"\u003e\n \u003cp\u003e404.00 (328.00, 443.00)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e-3.295\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: a\u003cem\u003e\u0026nbsp;P\u003c/em\u003e \u0026lt; 0.05 compared to preoperative in the same group.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6\u003c/strong\u003e Comparison of lung function between the two groups (L)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eCombined group (n = 43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eRoutine group (n = 43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cem\u003eZ\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eBefore surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eFVC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e3.00 (2.60, 3.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e3.10 (2.70, 3.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.886\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eFEV1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e2.70 (2.20, 2.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e2.80 (2.10, 3.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.614\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.539\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e1 month after surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eFVC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e2.30 (1.80, 2.70)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e2.00 (1.60, 2.20)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-3.042\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eFEV1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e1.80 (1.30, 2.10)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e1.50 (1.10, 1.80)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-2.277\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote: a\u003cem\u003e\u0026nbsp;P\u003c/em\u003e \u0026lt; 0.05 compared to preoperative in the same group.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7\u0026nbsp;\u003c/strong\u003eComparison of complications between the two groups [n(%)]\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eComplications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eCombined group (n = 43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eRoutine group (n = 43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026chi;\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eIncision infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e1 (2.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eIncision oozing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e1 (2.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e2 (4.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eThoracic infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e0 (0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e2 (4.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003ePleural effusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e1 (2.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e3 (6.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e2 (4.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e8 (18.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e4.074\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 8\u003c/strong\u003e Comparison of satisfaction between the two groups [n(%)]\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eSatisfaction degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eCombined group (n = 43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eRoutine group (n = 43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026chi;\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eDissatisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e2 (4.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e9 (20.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eSatisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e15 (34.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e15 (34.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eVery satisfied\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e26 (60.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e19 (44.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003eSatisfaction rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e41 (95.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e34 (79.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e5.108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Thoracoscopic radical resection of lung cancer, Fast track surgery, Clinical nursing pathway, Comfort care, Perioperative period, Application effect","lastPublishedDoi":"10.21203/rs.3.rs-6417828/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6417828/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis paper aimed to compare the application effect of fast track surgery-clinical nursing pathway (FTS-CNP) combined with comfort care in the perioperative period of patients undergoing thoracoscopic radical resection of lung cancer.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eEighty-six lung cancer patients who underwent thoracoscopic radical resection of lung cancer were retrospectively gathered and assigned into the routine group and the combined group following the different nursing methods (n\u0026thinsp;=\u0026thinsp;43 cases). The two groups adopted conventional nursing care, FTS-CNP combined with comfort care in the perioperative period, respectively. The postoperative rehabilitation indicators (the time of voluntary cough, out-of-bed activity, urinary catheter removal, chest tube removal, and hospitalization) and the Visual Analog Scale (VAS) scores at 6 h, 1 d, 3 d and 7 d after surgery were compared between the two groups. Self-Assessment Scale for Anxiety (SAS), Self-Assessment Scale for Depression (SDS), General Comfort Questionnaire (GCQ), and 6-min walking distance (6-MWD) were assessed preoperatively and 1 week postoperatively in both groups. Lung function [forced vital capacity (FVC) and forced expiratory volume in one second (FEV1)] was tested in both groups before and 1 month after surgery. Postoperative complications and satisfaction with care were counted in both groups.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe postoperative time for voluntary coughing, getting out of bed, urinary catheter removal, chest tube removal and hospitalization in the combined group was shorter versus the routine group. VAS scores at 6 h, 1 d, 3 d, and 7 d postoperatively were lower in the combined group than in the routine group. Lower SAS and SDS scores were observed in both groups at 1 week postoperatively, and they were lower in the combined group than in the routine group. GCQ scores increased and 6-MWD decreased in both groups at 1 week postoperatively, and both were higher in the combined group in contrast to the routine group. FVC and FEV1 were reduced in both groups 1 month after surgery, but they were higher in the combined group than in the routine group. Postoperative complications in the combined group were less, and satisfaction with care was higher than in the routine group.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eFTS-CNP combined with comfort care applied in the perioperative period of patients undergoing thoracoscopic radical resection of lung cancer helps to accelerate postoperative rehabilitation, reduces postoperative pain, relieves negative emotions, increases the patients\u0026rsquo; postoperative comfort, and improves exercise tolerance and lung function.\u003c/p\u003e","manuscriptTitle":"Application effect of fast track surgery-clinical nursing pathway combined with comfort care in the perioperative period of patients undergoing thoracoscopic radical resection of lung cancer","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-16 10:16:35","doi":"10.21203/rs.3.rs-6417828/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ea5f392c-fcf7-4704-bf98-00a4b3ca9ba9","owner":[],"postedDate":"May 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-08T08:24:12+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-16 10:16:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6417828","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6417828","identity":"rs-6417828","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}