Pre-op physiotherapy limits lung complications after upper abdominal surgery

Last Updated: 2018-01-31

By Will Boggs MD

NEW YORK (Reuters Health) - Preoperative physiotherapy beginning with a training session reduces respiratory complications after upper abdominal surgery, according to results from a randomized controlled trial.

"All patients awaiting major abdominal surgery should be trained by a physiotherapist before the operation on how to do postoperative breathing exercises," Ianthe J. Boden from Launceston General Hospital, Tasmania, and The University of Melbourne, in Australia, told Reuters Health by email. "If the physiotherapy service is left until after the surgery, it's probably too late."

The rate of respiratory complications after upper abdominal surgery is as high as 50%, and preoperative education and breathing-exercise training has reduced the risk of postoperative pulmonary complications (PPCs) by 75% in some studies.

Boden and colleagues in the Long Infection Prevention Post Surgery Major Abdominal with Pre-Operative Physiotherapy (LIPPSMAck-POP) trial investigated whether preoperative education and breathing-exercise training delivered within 6 weeks before surgery by physiotherapists could reduce the incidence of PPCs after upper abdominal surgery.

The 218 patients assigned to the intervention received a single 30-minute education and breathing-exercise coaching session with a physiotherapist immediately after standardized physiotherapy assessment and delivery of an education booklet. The 214 patients assigned to the control group received the information booklet alone.

Slightly less than half of patients in both groups were undergoing colorectal procedures; the rest were roughly evenly split between hepatobiliary/upper GI procedures and operations categorized as "renal/urology/other."

Overall, 20% of participants developed a PPC, with significantly fewer PPCs in the physiotherapy group (12%) than in the control group (27%), according to the January 24 BMJ online report.

After adjustment for baseline factors, physiotherapy was associated with a number needed to treat of 7 to prevent 1 PPC.

Hospital-acquired pneumonia occurred at less than half the frequency in the physiotherapy group than the control group (8% vs. 20%), but the groups did not differ significantly in other secondary outcomes.

The association between physiotherapy and reduced PPCs was most notable among patients with colorectal or upper abdominal surgery and was greatest in participants educated by an experienced physiotherapist. Education provided by experienced physiotherapists also was associated with shorter length of hospital stay and lower all-cause 12-month mortality.

"We tested just a single intervention (preoperative coaching of breathing exercises to be self-directed by the patient after surgery)," Boden explained. "There are other interventions (that) physiotherapists could also provide at preoperative clinics that could reduce the risk of respiratory complications further (inspiratory muscle training) and improve postoperative physical recovery (pre-habilitation, walking programs, strengthening exercises)."

"Physiotherapists need to become a strong part of the surgical team - as a profession, our interventions can strongly enhance recovery after surgery and prevent complications," she said. "Physiotherapists, surgeons, and physicians should partner together to focus on patient outcomes."

Dr. Takanori Numata from Jikei University School of Medicine, Tokyo, Japan, who recently reviewed risk factors of PPCs in patients with asthma and COPD, told Reuters Health by email, "I'm interested that the simple physiotherapy could reduce approximately 50% of PPCs after upper abdominal surgery."

"I think that it is difficult to standardize the physiotherapy by therapists, as the authors described in the limitations section," Dr. Numata concluded, adding that the therapy needs to be consistent with the specific resources of each hospital.

SOURCE: http://bit.ly/2GgoM9u

BMJ 2018.