Effects of preoperative physiotherapy on signs and symptoms of pulmonary collapse and infection after major abdominal surgery: secondary analysis of the LIPPSMAck-POP multicentre randomised controlled trial

Abstract

Background Preoperative education and breathing exercise training by a physiotherapist minimises pulmonary complications after abdominal surgery. Effects on specific clinical outcomes such as antibiotic prescriptions, chest imaging, sputum cultures, oxygen requirements, and diagnostic coding are unknown. Methods This post hoc analysis of prospectively collected data within a double-blinded, multicentre, randomised controlled trial involving 432 participants having major abdominal surgery explored effects of preoperative education and breathing exercise training with a physiotherapist on postoperative antibiotic prescriptions, hypoxemia, sputum cultures, chest imaging, auscultation, leukocytosis, pyrexia, oxygen therapy, and diagnostic coding, compared to a control group who received a booklet alone. All participants received standardised postoperative early ambulation. Outcomes were assessed daily for 14 postoperative days. Analyses were intention-to-treat using adjusted generalised multivariate linear regression. Results Preoperative physiotherapy was associated with fewer antibiotic prescriptions specific for a respiratory infection (RR 0.52; 95% CI 0.31 to 0.85, p = 0.01), less purulent sputum on the third and fourth postoperative days (RR 0.50; 95% CI 0.34 to 0.73, p = 0.01), fewer positive sputum cultures from the third to fifth postoperative day (RR 0.17; 95% CI 0.04 to 0.77, p = 0.01), and less oxygen therapy requirements (RR 0.49; 95% CI 0.31 to 0.78, p = 0.002). Treatment effects were specific to respiratory clinical coding domains. Conclusions Preoperative physiotherapy prevents postoperative pulmonary complications and is associated with the minimisation of signs and symptoms of pulmonary collapse/consolidation and airway infection and specifically results in reduced oxygen therapy requirements and antibiotic prescriptions. Trial registration ANZCTR 12613000664741; 19/06/2013.

Clinical Study of Preoperative Prehabilitation Synchronized Neoadjuvant Chemotherapy for Gastric Cancer Patients

“…Moreover, these improvements in physical functional and nutritional status continued up to 4 weeks postoperatively, which created favorable conditions for comprehensive postoperative treatment. Te results of our trial showed that the rate of pulmonary infections in patients in the prehabilitation group was signifcantly lower than that in the control group, indicating that the prehabilitation interventions can reduce the occurrence of perioperative pulmonary infections, which is also consistent with existing literature [37]. In contrast, there was no signifcant diference in the incidence of abdominal complications between the two groups, indicating that the improvement of physical function and the improvement of nutritional level had no signifcant efect on the prevention of abdominal complications.…”

Pre- and Postoperative Exercise Effectiveness in Mobility, Hemostatic Balance, and Prognostic Biomarkers in Hip Fracture Patients: A Study Protocol for a Randomized Controlled Trial

“…There is less evidence about the value of prehabilitation, which is, however, suggested as appropriate, or even necessary, both for the prevention of postoperative complications and the best outcome of surgery [68,69], as well as for the favorable cost-effectiveness it offers [70]. Based on the existing literature on both the benefits of aerobic exercise on cardiorespiratory health and functionality in patients with hip fractures [17,64], the positive regulation it brings about in biochemical markers such as hypercoagulability [22,23] and albumin [71,72], we hypothesize that a pre-and postoperative exercise program can provide a comprehensive, multidimensional and multisystemic benefit to patients after a hip fracture.…”

The Benefits of Early Mobilization on Post-Abdominal Surgery: A Review of Literature

“…These complications occur due to atelectasis or severe pneumonia that may lead to respiratory failure or death. 6,7 The PPC complication makes prolonged treatment of the patients from the recovery room and the post-surgical room to fully recover. PPC is a common term for pulmonary complications after a surgical operation.…”

“…These complications occur due to atelectasis or severe pneumonia that may lead to respiratory failure or death. 6,7 PPC is a common term for pulmonary complications after a surgical operation. The reported incidence of this complication ranged from 1 to 40%, depending on the definitions of PPC and the types of surgery.…”