Respiratory Training Before Surgery Significantly Reduces Risk of Postoperative Lung Complications

Highlights:

• Patients who started simple breathing exercises immediately after upper abdominal surgery had half the incidence of postoperative lung complications than those who did not perform the exercises.
• Physiotherapists taught the breathing techniques to the patients within six weeks before the operation.
• Upper abdominal surgery is one of the most commonly performed surgical procedures and is associated with a risk of serious lung complications such as pneumonia and lung collapse.

Serious lung complications that might occur following upper abdominal surgery results in increased patient mortality and morbidity; it also places a considerable burden on healthcare costs. These could be significantly reduced by training patients awaiting surgery to do simple breathing exercises as soon as the operation is over, according to the current study done by a team of scientists from Australia and New Zealand. The details of the study have been published in the British Medical Journal (BMJ) The current study follows earlier research that seemed to suggest that simple respiratory intervention might reduce lung complications postoperatively. However, the results of these trials were not conclusive.

Breathing Training to Reduce Post-op Lung Complications – The Study

• The study involved 441 participants awaiting elective upper abdominal surgery in the following six weeks.
• Participants were randomly provided with an information leaflet (controls) or were given an one on one training for 30 minutes by a qualified physiotherapist to do simple breathing exercises immediately after surgery (intervention group).
• All patients were regularly assessed for two weeks postoperatively for the incidence of lung complications.
• Other parameters such as length of hospital stay, availing intensive care unit services, and other causes of mortality were also considered. Patient factors such as patient age and presence of other concurrent illnesses (comorbidities) were also taken into account.

The results showed that the occurrence of pulmonary complications in the first two weeks after surgery, such as hospital-acquired pneumonia, was reduced by half in the intervention group in comparison to the control group, with an absolute reduction of risk of 15%.

• No significant change in other outcomes was noted.
• The association was more evident in patients under 65 years of age, those undergoing bowel surgery and when the interventional breathing training was given by an experienced physiotherapist.
• The study team estimates that occurrence of lung complication is prevented in at least one out of every seven persons trained to do the breathing exercises.

According to the research team their results "are directly applicable to the tens of millions of patients listed for elective major abdominal surgery worldwide" and that this (respiratory training) service "could be considered for all patients awaiting upper abdominal surgery."

The limitations of the study were imbalances in the control and intervention groups in the initial stages of the trial, and restricting the study only to English speaking persons from the developed world. After making appropriate adjustments for the presence of confounding factors, the analysis of the results further strengthened the association of physiotherapy training to decreased postoperative lung complications.

According to the scientists, “this trial provides strong evidence that a single preoperativephysiotherapy session that educates patients on the reason and necessity to do breathing exercises immediately after surgery halves the incidence of postoperative respiratory complications."

Future Plans

Further studies are being planned to evaluate the benefit of physiotherapy in reducing mortality and the duration of stay in a hospital.

Reference:

1. Elizabeth H Skinner et al., Preoperative physiotherapy for the prevention of respiratory complications after upper abdominal surgery: pragmatic, double blinded, multicentre randomised controlled trial. The BMJ (2018) DOI: https://doi.org/10.1136/bmj.j5916

Source-Medindia