Ultra-early initiation of postoperative rehabilitation in the post-anaesthesia care unit after major thoracic surgery: case–control study

Abstract

Background Physiotherapy is a major cornerstone of enhanced rehabilitation after surgery (ERAS) and reduces the development of atelectasis after thoracic surgery. By initiating physiotherapy in the post-anaesthesia care unit (PACU), the aim was to evaluate whether the ultra-early initiation of rehabilitation (in the first hour following tracheal extubation) would improve the outcomes of patients undergoing elective thoracic surgery. Methods A case–control study with a before-and-after design was conducted. From a historical control group, patients were paired at a 3:1 ratio with an intervention group. This group consisted of patients treated with the ultra-early rehabilitation programme after elective thoracic surgery (clear fluids, physiotherapy, and ambulation). The primary outcome was the incidence of postoperative atelectasis and/or pneumonia during the hospital stay. Results After pairing, 675 patients were allocated to the historical control group and 225 patients to the intervention group. A significant decrease in the incidence of postoperative atelectasis and/or pneumonia was found in the latter (11.4 versus 6.7 per cent respectively; P = 0.042) and remained significant on multivariate analysis (OR 0.53, 95 per cent c.i. 0.26 to 0.98; P = 0.045). A subgroup analysis of the intervention group showed that early ambulation during the PACU stay was associated with a further significant decrease in the incidence of postoperative atelectasis and/or pneumonia (2.2 versus 9.5 per cent; P = 0.012). Conclusions Ultra-early rehabilitation in the PACU was associated with a decrease in the incidence of postoperative atelectasis and/or pneumonia after major elective thoracic surgery.

Reducing the carbon footprint of general anaesthesia: a comparison of total intravenous anaesthesia vs. a mixed anaesthetic strategy in 47,157 adult patients

“…In patients who are obese, the use of volatile anaesthetic agents has been reported to reduce the time it takes for patients to become fully awake, but this reduction may not be considered clinically significant and remains a topic of debate [37, 38]. Lastly, a recent study conducted in our institution suggested the feasibility of very early initiation of postoperative rehabilitation in the post‐anaesthesia care unit following major thoracic surgery after general anaesthesia with TIVA [39]. Nevertheless, the superiority of TIVA vs. volatile‐based techniques remains controversial, and there are currently two major studies investigating this issue [40, 41].…”

“…Lastly, a recent study conducted in our institution suggested the feasibility of very early initiation of postoperative rehabilitation in the post-anaesthesia care unit following major thoracic surgery after general anaesthesia with TIVA [39]. Nevertheless, the superiority of TIVA vs. volatile-based techniques remains controversial, and there are currently two major studies investigating this issue [40,41].…”