Researchers at Launceston General Hospital (Australia), the University of Melbourne (UNIMELB; Parkville, Australia), and other institutions conducted a study to assess the efficacy of a single preoperative physiotherapy session to reduce PPCs after upper abdominal surgery. The prospective study involved 441 patients at three public hospitals in Australia and New Zealand who were randomly assigned through concealed allocation to receive either an information booklet (219 patients) or preoperative physiotherapy (222 patients).
The primary outcome, the researchers noted in their recent BMJ study report, was a PPC within 14 postoperative hospital days. Secondary outcomes included hospital-acquired pneumonia, length of hospital stay, utilization of intensive care unit (ICU) services, and hospital costs.
Patient reported outcomes included health related quality of life and physical function. In addition, post-discharge complications were measured at six weeks post-surgery, and all-cause mortality was measured at 12 months; in all, 432 patients completed the trial.
The results revealed that the incidence of PPCs within 14 postoperative hospital days, including hospital acquired pneumonia, was halved in the intervention group. The association was stronger in patients undergoing colorectal surgery, in patients younger than 65, men, or if an experienced physiotherapist provided the training. The researchers also estimated that for every seven patients given breathing training before surgery, one PPC was avoided. No significant differences in other secondary outcomes were detected.
“This trial provides strong evidence that a single preoperative physiotherapy session that educates patients on the reason and necessity to do breathing exercises immediately after surgery halves the incidence of postoperative respiratory complications,” concluded lead author cardiorespiratory physiotherapist Ianthe Boden, BAppSc, MSc, of Launceston General Hospital, and colleagues. “We recommend that future studies should investigate additional PPC prophylactic interventions to augment preoperative physiotherapy education, particularly targeting high risk patients.”
RESEARCH: Boden et al: Preoperative physiotherapy for the prevention of respiratory complications after upper abdominal surgery: pragmatic, double blinded, multicentre randomised controlled trial; http://www.bmj.com/content/360/bmj.j5916