Prevalidation for upper abdominal surgery
A randomized placebo-controlled study was conducted in multidisciplinary clinics of three tertiary public hospitals in Australia and New Zealand to evaluate the efficacy of preoperative physiotherapy sessions and to reduce postoperative pulmonary complications (PPCs) after upper abdominal surgery.
441 Adults 18 years of age or older were assigned an open upper abdominal surgery within six weeks by lottery to receive either an information booklet (n = 219; check) or preoperative physiotherapy (n = 222; intervention) for 12 months and to become followed proactively. Pre-operatively, the participants received an information booklet (control group) or an additional 30-minute prevalidation of physiotherapy and breathing exercises (intervention group). The information booklet prescribes breathing exercises consisting of two sets of 10 slow deep breaths, followed by three times of huffing. These exercises were performed every hour and started immediately after the operation. No physiotherapeutic information other than that included in the booklet was provided to inform the participants. The primary result was a PPC within 14 post-operative hospital days that were assessed daily on the basis of the Melbourne group score. Secondary outcomes were hospital-acquired pulmonary complications, the length of stay in the hospital, the use of services in the intensive care unit and hospital costs. Patients report health-related quality of life. Physical function and complications after discharge were measured after six weeks and all deaths were measured up to 12 months. The 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 to the control group, with a absolute risk reduction of 15% (95% confidence interval 7% to 22%). No significant differences in other secondary outcomes were detected.
The study provides strong evidence that information relating to physiotherapy, education and prevalidation provided by a physical therapist within six weeks prior to an upper abdominal surgery reduces the incidence of PPCs, including hospital impairment, within the first 14 days after surgery. In a general population of patients admitted for elective upper abdominal surgery, a 30-minute preoperative physiotherapeutic session halves the incidence of PPCs (particularly hospitalized pneumonia) offered in existing multidisciplinary clinics of hospitals.
Physical Therapy Science