Association of postoperative orthostatic intolerance with early recovery quality and clinical outcomes following thoracoscopic pulmonary resection: a propensity-matched study.

BACKGROUND: Postoperative orthostatic intolerance (OI) is frequently observed during early mobilization after surgery, yet its impact on early recovery following thoracoscopic pulmonary resection remains unclear. This study evaluated the association between OI and early recovery outcomes. METHODS: This prospective cohort study included 211 patients undergoing thoracoscopic pulmonary resection. OI was recorded during the first mobilization. Recovery was assessed using Quality of Recovery-9 (QoR-9) scores (postoperative days 1-3), discharge 6-minute walk distance (6MWD), drainage duration, and hospital stay. Propensity score matching (PSM) was applied to adjust for baseline differences. RESULTS: Before matching, 64 patients experienced OI and 147 did not, differing significantly in sex and smoking history (P<0.05). After PSM (n=64/group), QoR-9 scores were consistently lower in the OI group on postoperative day 1 (9.72 vs. 11.08, P<0.001), day 2 (12.05 vs. 12.95, P=0.006), and day 3 (13.89 vs. 14.58, P=0.02). Patients with OI had longer drainage duration (87.75 vs. 79.00 hours, P=0.004) and higher odds of postoperative hospital stays of 5-10 days [odds ratio (OR) =2.86, 95% confidence interval (CI): 1.20-6.82] and ≥11 days (OR =10.03, 95% CI: 1.18-84.96). However, no significant difference in discharge 6MWD was observed (351.64 vs. 376.52 meters, P=0.10). CONCLUSIONS: Postoperative OI is associated with clinically meaningful reductions in early recovery quality, particularly during the first two postoperative days, and with prolonged hospitalization, but not with reduced functional walking capacity at discharge. These findings suggest that OI represents a transient but clinically relevant factor in early recovery trajectories following thoracoscopic lung surgery.