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Pre-surgery breathing physio halves risk of complications

Consider pre-op breathing training with physiotherapist before major abdominal surgery

Louise Prime

Thursday, 25 January 2018

Just 30 minutes’ physiotherapy on how to perform breathing exercises immediately on waking from major abdominal surgery halved the incidence of pneumonia and other serious lung complications, in a trial in Australia and New Zealand. The researchers behind the study,* published today in The BMJ, said that although more research is needed to investigate benefits in terms of mortality and length of stay, this service could be considered for all patients awaiting upper abdominal surgery.

The researchers pointed out that upper abdominal surgery is the most frequent major surgical procedure performed in developed countries, and that a postoperative pulmonary complication (PPC) is the most common serious complication after this type of surgery, with a reported incidence of 10-50% of patients. They designed a trial to assess the efficacy of a single preoperative physiotherapy session to reduce PPCs after upper abdominal surgery.

They randomly assigned 441 adults, who were within six weeks of elective major open upper abdominal, to receive either an information booklet (219 control patients) or an additional preoperative 30-minute physiotherapy education and breathing exercise training session (222 intervention patients). Education focused on PPCs and their prevention through early ambulation and self-directed breathing exercises to be initiated immediately on regaining consciousness after surgery; postoperatively, all participants received standardised early ambulation.

Participants were followed for 12 months. Among the 432 participants who completed the trial, intervention patients had less than half the incidence of PPCs, including hospital-acquired pneumonia, within 14 postoperative days compared with control patients (hazard ratio 0.48). The absolute risk reduction was 15%, and the number needed to treat was seven. The researchers found no significant differences between the two groups in secondary outcomes, including length of hospital stay, hospital costs or all-cause mortality at 12 months.

They said that despite some limitations of their study, it “provides strong evidence that preoperative education and training delivered within six weeks of open upper abdominal surgery by a physiotherapist reduces the incidence of PPCs, including hospital acquired pneumonia, within the first 14 days after surgery” and that its results are “directly applicable to the tens of millions of patients listed for elective major abdominal surgery worldwide”.

They pointed out that the single 30-minute intervention had minimal potential to harm and was provided within existing multidisciplinary hospital clinics that patients are already required to attend before surgery, and concluded: “This service could be considered for all patients awaiting upper abdominal surgery.”

* 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. BMJ 2018; 360: j5916. DOI: 10.1136/bmj.j5916

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