Abstract
BackgroundPreoperative education and breathing exercise training by a physiotherapist minimises pulmonary complications after abdominal surgery. Effects on specific clinical outcomes such as antibiotic prescriptions, chest imaging, sputum cultures, oxygen requirements, and diagnostic coding are unknown.MethodsThis post hoc analysis of prospectively collected data within a double-blinded, multicentre, randomised controlled trial involving 432 participants having major abdominal surgery explored effects of preoperative education and breathing exercise training with a physiotherapist on postoperative antibiotic prescriptions, hypoxemia, sputum cultures, chest imaging, auscultation, leukocytosis, pyrexia, oxygen therapy, and diagnostic coding, compared to a control group who received a booklet alone. All participants received standardised postoperative early ambulation. Outcomes were assessed daily for 14 postoperative days. Analyses were intention-to-treat using adjusted generalised multivariate linear regression.ResultsPreoperative physiotherapy was associated with fewer antibiotic prescriptions specific for a respiratory infection (RR 0.52; 95% CI 0.31 to 0.85, p = 0.01), less purulent sputum on the third and fourth postoperative days (RR 0.50; 95% CI 0.34 to 0.73, p = 0.01), fewer positive sputum cultures from the third to fifth postoperative day (RR 0.17; 95% CI 0.04 to 0.77, p = 0.01), and less oxygen therapy requirements (RR 0.49; 95% CI 0.31 to 0.78, p = 0.002). Treatment effects were specific to respiratory clinical coding domains.ConclusionsPreoperative physiotherapy prevents postoperative pulmonary complications and is associated with the minimisation of signs and symptoms of pulmonary collapse/consolidation and airway infection and specifically results in reduced oxygen therapy requirements and antibiotic prescriptions.Trial registrationANZCTR 12613000664741; 19/06/2013.
Highlights
Preoperative education and breathing exercise training by a physiotherapist minimises pulmonary complications after abdominal surgery
The hypothesis was that repetitive independent performance of breathing exercises in the early postoperative period would reverse atelectasis and improve sputum clearance resulting in reduced risk of a pulmonary complications (PPC)
In a deliberate effort to minimise Hawthorne effects, the performance of breathing exercises was not directly measured (Boden et al 2018a; Boden et al 2015; Boden et al 2018b). It cannot be stated with absolute certainty that the mechanism of effect for PPC reduction in the LIPPSMAck-POP trial were self-directed breathing exercises
Summary
Preoperative education and breathing exercise training by a physiotherapist minimises pulmonary complications after abdominal surgery. Effects on specific clinical outcomes such as antibiotic prescriptions, chest imaging, sputum cultures, oxygen requirements, and diagnostic coding are unknown. The hypothesis was that repetitive independent performance of breathing exercises in the early postoperative period would reverse atelectasis and improve sputum clearance resulting in reduced risk of a PPC. Positive effects on physiological outcomes would provide concurrent validity to the primary results and support the hypothesis that preoperative physiotherapy enables patients to perform breathing exercises after surgery. This information would assist perioperative health professionals and hospital administrators to understand the impact that physiotherapy has on important tangible postoperative clinical outcomes, and this may strengthen the case for widespread implementation of this service
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