Preoperative physical activity has a protective effect against postoperative pulmonary complications after abdominal surgery

Fernando Wegner,Daniel Correia Souza,Luciana Dias Chiavegato,Adriana Claudia Lunardi,Elinaldo Da Conceição Dos Santos

doi:10.33233/fb.v21i4.3971

Abstract

Physical activity level and fitness condition seem to be related with pulmonary surgical risk in thoracic and cardiac surgeries; however, in abdominal surgery this relation is not clear. Objective: To compare the physical activity level in daily life and during hospitalization before surgery between patients who developed and did not develop postoperative pulmonary complications (PPC) after abdominal surgery and to relate to this outcome. Methods: This prospective cohort enrolled 191 hospitalized candidates (52 ± 14yrs; BMI = 29 ± 11 kg/m2) for upper abdominal surgery. Two different tools related to two distinct moments were used to assess preoperatively the physical activity level. First, to assess life physical activity level, the questionnaire Human Activity Profile (HAP) was administered for all patients. During hospitalization, the accelerometry was performed during 4 consecutive days to assess the time in activity. In addition, lung function, muscle strength and resting energy expenditure were assessed. PPC (pneumonia, atelectasis or severe hypoxemia) were checked until discharge. Multivariate analyses were used. Results: 92% of patients were classified as moderately to physically active in daily life. During hospitalization, patients were inactive during 90% ± 5% of time. There was no association with HAP score and acelerometry. 10.5% of patients developed PPC. Being physically active in daily life and during hospitalization have a protective effect against PPC. Our results show that the physical activity behavior in hospital do not reflect the daily life even in patients not restricted to bed and on preoperative period, patients physically actives on daily life and during hospitalization present less chance to develop PPC after abdominal surgery.Keywords: surgery, physical activity, postoperative complication, pneumonia, accelerometry, hospitalization.

Highlights

Postoperative pulmonary complications (PPC) are frequent after major surgeries [1] and increase the morbidity and mortality risks and the length of hospital stay [2]
After they had signed the consent forms, the patients were assessed for anthropometric characteristics, medical history, serum albumin level, lung function, muscle strength, resting energy expenditure, the physical activity level on daily life and during hospitalization before surgery
BMI=body mass index; n=absolute number; PPC=postoperative pulmonary complication; FVC=forced vital capacity; FEV1=forced expiratory volume in the 1st. second; ASA=American Society of Anesthesiology Index; cmH2O=centimeter of water; Kgf=kilogram force; min=minutes; kcal=kilocalorie; PPC=postoperative pulmonary complications; p

Summary

Introduction

Postoperative pulmonary complications (PPC) are frequent after major surgeries [1] and increase the morbidity and mortality risks and the length of hospital stay [2]. The poor exercise tolerance has been considerate as a risk factor for developing of postoperative complications after cardiothoracic [4,5] and non-cardiothoracic surgeries [6,7]. Patients with poor exercise tolerance, especially those with chronic respiratory diseases, frequent present the harms from a sedentary lifestyle as the early development of other chronic diseases, obesity, deficit of oxygen transport and impaired functionality [9]. Cook et al observed that patients with poor exercise tolerance had presented higher risk for complications and longer length of hospital stay after cardiac surgery [10]. The evidences that physical activity programs decrease the incidence of PPC after major surgeries stills weak [11,12]

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Results

Conclusion