- 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.
that might occur following upper abdominal surgery
results in increased patient mortality
places a considerable burden on
. These could be significantly reduced by training patients awaiting surgery to do simple breathing
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
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
- All patients were regularly
assessed for two weeks postoperatively for the incidence of lung
- 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%.
‘Including respiratory physiotherapy training as a routine service to all patients awaiting upper abdominal surgery improves patient outcome and also optimizes healthcare costs.’
- 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 study were
imbalances in the control and intervention groups in the initial stages of the trial, and restricting the study only
speaking persons from the developed world. After making appropriate
adjustments for the presence
of confounding factors,
the analysis of the results
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."
Further studies are being planned to
evaluate the benefit of physiotherapy in reducing mortality and the duration of
stay in a hospital.
- 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