Peri-operative physiotherapy

Abstract

Postoperative pulmonary complications (PPC) are a major cause of morbidity, mortality, prolonged hospital stay, and increased cost of care. Physiotherapy (PT) programs in post-surgical and critical area patients are aimed to reduce the risks of PPC due to long-term bed-rest, to improve the patient’s quality of life and residual function, and to avoid new hospitalizations. At this purpose, PT programs apply advanced cost-effective therapeutic modalities to decrease complications and patient’s ventilator-dependency. Strategies to reduce PPC include monitoring and reduction of risk factors, improving preoperative status, patient education, smoking cessation, intra-operative and postoperative pulmonary care. Different PT techniques, as a part of the comprehensive management of patients undergoing cardiac, upper abdominal, and thoracic surgery, may prevent and treat PPC such as secretion retention, atelectasis, and pneumonia.

Can nurse-led preoperative education reduce anxiety and postoperative complications of patients undergoing cardiac surgery?

“…The objective of providing preoperative education to patients undergoing cardiac surgery is to prevent or reduce anxiety and postoperative complications that are associated with morbidity, mortality and prolonged hospital stay as well as hastening postoperative recovery. 22 The complications that may be associated with lack of patients' preoperative education are pulmonary infection, 23 atelectasis, 24 deep vein thrombosis, 24,25 wound infections 26,27 and split of the sternum. 28 Sternal dehiscence, wound infections 29 and arrhythmia were the most common causes for unplanned 30-day hospital readmissions after cardiac surgery.…”

“…30 For example, early mobilisation and muscle training can improve functional outcomes as well as cognitive and respiratory conditions, and reduce the risk of venous stasis and deep vein thrombosis. 24 Interventions such as breathing and coughing exercises before CABG surgery were shown to be effective and were able to lower the risk of pneumonia and atelectasis. 24,31,32 Extension of the length of stay (LOS) in the intensive care unit (ICU) has been associated with negative short and long-term postoperative outcomes.…”

Effectiveness of preoperative physical therapy for older patients with hip fracture

“…First, preoperative rehabilitation prevents complications of pneumonia, deep vein thrombosis and muscle weakness. Preoperative mobilization could improve respiratory function and prevent pulmonary complications, reducing the risk of venous stasis and deep vein thrombosis . Immobility is the main cause of muscle weakness in older patients, and perioperative physiotherapy could help prevent muscle dysfunction and progression of disability.…”

Perioperative physiotherapy in patients undergoing lung cancer resection

“…Several strategies and interventions have been developed in an attempt to reduce the incidence of PPCs: screening for and modification of risk factors, optimization of preoperative status, patient education, intraoperative management and postoperative pulmonary care [12]. Physiotherapy has been regularly utilized in both pre-and postoperative care with the aim of preventing or reducing complications [13,14] and has recently been recommended by the European Respiratory Society, the European Society of Thoracic Surgeons and the American College of Chest Physicians for providing functional benefits [15,16].…”