Do preoperative pulmonary functions determine cough effectiveness early after laparoscopic bariatric surgery?

Abstract

Background and Aim: Cough is a protective mechanism providing bronchial drainage to protect secretion retention after abdominal surgeries. Although postoperative pulmonary complications are low after laparoscopic bariatric surgery (LBS), studies showed an increase in complications in patients with abnormal pulmonary function test (PFT) results. Our aim was to detect if preoperative PFT determines cough effectiveness early after LBS. Methods: 26 patients underwent LBS were included. PFT (FEV 1, FVC, FEV 1 /FVC, and PEF) was performed before surgery. Patients were instructed to perform a cough maneuver on the 1 st postoperative day. The maneuver was applied while the patient was sitting on the edge of the bed with an abdominal support via a pillow after a maximum inspiration. Peak expiratory flow rate during coughing (cough PEFR) was measured with a peak flow meter to determine cough effectiveness. Incision pain during cough was assessed with Visual Analog Scale (0-10). Pearson Correlation Analyses was used for statistical analysis. Results: There were 19 females and 7 males with 38.88±10.31 years. Positive correlation was found between cough PEFR and preoperative PEF (rho=0.538, p=0.007), but not FEV 1, FVC, and FEV 1 /FVC values (p>0.05). Cough PEFR was negatively correlated with incision pain (rho=-0.049, p=0.021). Conclusion: Preoperative PEF measurements during PFT are valuable to detect patients who would probably not able to cough effectively after LBS. Preoperative expiratory muscle and cough training will help to prevent pulmonary complications in obese patients with abnormal PEF results. Postoperative effective pain control is also crucial to provide an effective cough.