Preoperative physiotherapy for the prevention of respiratory complications after upper abdominal surgery: pragmatic, double blinded, multicentre randomised controlled trial

AbstractObjectiveTo assess the efficacy of a single preoperative physiotherapy session to reduce postoperative pulmonary complications (PPCs) after upper abdominal surgery.DesignProspective, pragmatic, multicentre, patient and assessor blinded, parallel group, randomised placebo controlled superiori...

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Bibliographic Details
Published in:BMJ (Online) 2018-01, Vol.360, p.j5916-j5916
Main Authors: Boden, Ianthe, Skinner, Elizabeth H, Browning, Laura, Reeve, Julie, Anderson, Lesley, Hill, Cat, Robertson, Iain K, Story, David, Denehy, Linda
Format: Article
Language:English
Subjects:
Abdomen
Abdomen - surgery
Abdominal surgery
Adult
Aged
Australia
Clinical trials
Clinics
Double-Blind Method
Education
Elective Surgical Procedures - adverse effects
Evidence-based medicine
Female
Fitness training programs
Hospitals
Humans
Intervention
Joint surgery
Male
Middle Aged
Mortality
New Zealand
Patients
Physical therapy
Physical Therapy Modalities
Pneumonia
Postoperative Complications - prevention & control
Postoperative period
Preoperative Care
Prevention
Prospective Studies
Quality of life
Respiration
Respiratory Tract Diseases - prevention & control
Surgeons
Surgery
Systematic review
Thoracic surgery
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Summary:AbstractObjectiveTo assess the efficacy of a single preoperative physiotherapy session to reduce postoperative pulmonary complications (PPCs) after upper abdominal surgery.DesignProspective, pragmatic, multicentre, patient and assessor blinded, parallel group, randomised placebo controlled superiority trial.SettingMultidisciplinary preadmission clinics at three tertiary public hospitals in Australia and New Zealand.Participants441 adults aged 18 years or older who were within six weeks of elective major open upper abdominal surgery were randomly assigned through concealed allocation to receive either an information booklet (n=219; control) or preoperative physiotherapy (n=222; intervention) and followed for 12 months. 432 completed the trial.InterventionsPreoperatively, participants received an information booklet (control) or an additional 30 minute physiotherapy education and breathing exercise training session (intervention). Education focused on PPCs and their prevention through early ambulation and self directed breathing exercises to be initiated immediately on regaining consciousness after surgery. Postoperatively, all participants received standardised early ambulation, and no additional respiratory physiotherapy was provided.Main outcome measuresThe primary outcome was a PPC within 14 postoperative hospital days assessed daily using the Melbourne group score. Secondary outcomes were hospital acquired pneumonia, length of hospital stay, utilisation of intensive care unit services, and hospital costs. Patient reported health related quality of life, physical function, and post-discharge complications were measured at six weeks, and all cause mortality was measured to 12 months.ResultsThe incidence of PPCs within 14 postoperative hospital days, including hospital acquired pneumonia, was halved (adjusted hazard ratio 0.48, 95% confidence interval 0.30 to 0.75, P=0.001) in the intervention group compared with the control group, with an absolute risk reduction of 15% (95% confidence interval 7% to 22%) and a number needed to treat of 7 (95% confidence interval 5 to 14). No significant differences in other secondary outcomes were detected.ConclusionIn a general population of patients listed for elective upper abdominal surgery, a 30 minute preoperative physiotherapy session provided within existing hospital multidisciplinary preadmission clinics halves the incidence of PPCs and specifically hospital acquired pneumonia. Further research is required to inv
ISSN:0959-8138
1756-1833
DOI:10.1136/bmj.j5916