Reducing Postoperative Respiratory Complications Through Physiotherapy

Preoperative education and training delivered by a physiotherapist within 6 weeks prior to open upper abdominal surgery significantly reduced the incidence of postoperative pulmonary complications (PPCs), including hospital-acquired pneumonia, within the first 14 days after surgery, according to a study published in the British Medical Journal.

Researchers evaluated the results of a prospective, multicenter, double-blind, parallel group, controlled superiority trial that took place in multidisciplinary preadmission clinics at 3 tertiary public hospitals in Australia and New Zealand. A total of 441 adults were randomly assigned to receive either an information booklet (n=219) or one 30-minute preoperative physiotherapy education and breathing exercise-training session (n=222). Education focused on PPCs and their prevention through early ambulation and self-directed breathing exercises to be started on regaining consciousness after surgery. Patients were followed for 12 months after surgery; 432 people completed the trial. The primary outcome was PPC within 14 postoperative hospital days.

The preoperative physiotherapy intervention cut the incidence of PPCs by 50% (adjusted hazard ratio, 0.48; P =.001), including the incidence of hospital-acquired pneumonia, compared with the control group (information booklet). The absolute risk reduction was 15%, and the number needed to treat was 7. No significant differences were detected for other outcomes.

The authors noted several limitations, including the exclusion of non-English speakers from the trial, and that the trial was only conducted in developed Western countries and most of the participants came from a single hospital in Australia. They also noted that there were fewer reductions in PPCs at the New Zealand site than at Australian sites, possibly as a result of differences in experience level of the preoperative physiotherapists.

Nonetheless, the authors concluded that preoperative education and training within 6 weeks before open upper abdominal surgery was beneficial in reducing the incidence of PPCs, with minimal potential to cause harm. They suggested that further research is required to investigate benefits to mortality and length of stay.

Reference

Boden I, Skinner EH, Browning L, et al. Preoperative physiotherapy for the prevention of respiratory complications after upper abdominal surgery: pragmatic, double blinded, multicentre, randomised controlled trial [published online January 24, 2018]. BMJ. doi:10.1136/bmj.j5916