Preoperative physiotherapy prevents postoperative pulmonary complications after major abdominal surgery: a meta-analysis of individual patient data

IF 9.7 1区医学 Q1 ORTHOPEDICS Journal of Physiotherapy Pub Date : 2024-07-01 DOI:10.1016/j.jphys.2024.02.012

Ianthe Boden , Julie Reeve , Anna Jernås , Linda Denehy , Monika Fagevik Olsén

{"title":"Preoperative physiotherapy prevents postoperative pulmonary complications after major abdominal surgery: a meta-analysis of individual patient data","authors":"Ianthe Boden , Julie Reeve , Anna Jernås , Linda Denehy , Monika Fagevik Olsén","doi":"10.1016/j.jphys.2024.02.012","DOIUrl":null,"url":null,"abstract":"<div><h3>Questions</h3><p>Among patients having elective abdominal surgery, how much does preoperative physiotherapy education with breathing exercise training reduce the incidence of postoperative pulmonary complications (PPCs), hospital length of stay and 12-month mortality? How stable are the treatment effects across different PPC definitions, including pneumonia? How much do the treatment effects on PPC, hospital length of stay and mortality vary within clinically relevant subgroups?</p></div><div><h3>Design</h3><p>Individual participant-level meta-analysis (n = 800) from two randomised controlled trials analysed with multivariable regression.</p></div><div><h3>Participants</h3><p>Adults undergoing major elective abdominal surgery.</p></div><div><h3>Interventions</h3><p>Experimental participants received a single preoperative session with a physiotherapist within 4 weeks of surgery and educated on PPC prevention with breathing exercises and early mobilisation. They were taught breathing exercises and instructed to start them immediately on waking from surgery. The control group received no preoperative or postoperative physiotherapy, or early ambulation alone.</p></div><div><h3>Outcome measures</h3><p>PPC, hospital length of stay and 12-month mortality.</p></div><div><h3>Results</h3><p>Participants who received preoperative physiotherapy had 47% lower odds of developing a PPC (adjusted OR 0.53, 95% CI 0.34 to 0.85). This effect was stable regardless of PPC definition. Effects were greatest in participants who smoked, were aged ≤ 45 years, had abnormal body weight, had multiple comorbidities, or were undergoing bariatric or upper gastrointestinal surgery. Participants having operations ≤ 3 hours in duration were least responsive to preoperative physiotherapy. Participants with multiple comorbidities were more likely to have a shorter hospital stay if provided with preoperative physiotherapy (adjusted MD –3.2 days, 95% CI –6.2 to –0.3). Effects on mortality were uncertain.</p></div><div><h3>Conclusion</h3><p>There is strong evidence to support preoperative physiotherapy in preventing PPCs after elective abdominal surgery.</p></div>","PeriodicalId":49153,"journal":{"name":"Journal of Physiotherapy","volume":null,"pages":null},"PeriodicalIF":9.7000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1836955324000134/pdfft?md5=10f987c1280704d4686c4582a50f0a8d&pid=1-s2.0-S1836955324000134-main.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Physiotherapy","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1836955324000134","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}

引用次数: 0

Abstract

Questions

Among patients having elective abdominal surgery, how much does preoperative physiotherapy education with breathing exercise training reduce the incidence of postoperative pulmonary complications (PPCs), hospital length of stay and 12-month mortality? How stable are the treatment effects across different PPC definitions, including pneumonia? How much do the treatment effects on PPC, hospital length of stay and mortality vary within clinically relevant subgroups?

Design

Individual participant-level meta-analysis (n = 800) from two randomised controlled trials analysed with multivariable regression.

Participants

Adults undergoing major elective abdominal surgery.

Interventions

Experimental participants received a single preoperative session with a physiotherapist within 4 weeks of surgery and educated on PPC prevention with breathing exercises and early mobilisation. They were taught breathing exercises and instructed to start them immediately on waking from surgery. The control group received no preoperative or postoperative physiotherapy, or early ambulation alone.

Outcome measures

PPC, hospital length of stay and 12-month mortality.

Results

Participants who received preoperative physiotherapy had 47% lower odds of developing a PPC (adjusted OR 0.53, 95% CI 0.34 to 0.85). This effect was stable regardless of PPC definition. Effects were greatest in participants who smoked, were aged ≤ 45 years, had abnormal body weight, had multiple comorbidities, or were undergoing bariatric or upper gastrointestinal surgery. Participants having operations ≤ 3 hours in duration were least responsive to preoperative physiotherapy. Participants with multiple comorbidities were more likely to have a shorter hospital stay if provided with preoperative physiotherapy (adjusted MD –3.2 days, 95% CI –6.2 to –0.3). Effects on mortality were uncertain.

Conclusion

There is strong evidence to support preoperative physiotherapy in preventing PPCs after elective abdominal surgery.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

术前物理治疗可预防腹部大手术后肺部并发症：对患者个体数据的荟萃分析。

问题在择期腹部手术患者中，术前物理治疗教育与呼吸运动训练能在多大程度上降低术后肺部并发症（PPC）的发生率、住院时间和 12 个月的死亡率？在不同的 PPC 定义（包括肺炎）下，治疗效果的稳定性如何？在临床相关的亚组中，对肺部并发症、住院时间和死亡率的治疗效果有多大差异？来自两项随机对照试验的个人参与者水平荟萃分析（n = 800），采用多变量回归分析：干预：实验参与者在手术前 4 周内接受理疗师的一次术前治疗，并接受通过呼吸练习和早期活动预防 PPC 的教育。他们接受了呼吸练习，并被要求在手术后立即开始呼吸练习。对照组不接受术前或术后物理治疗，或仅进行早期活动：结果：PPC、住院时间和 12 个月死亡率：结果：接受术前物理治疗的参与者发生 PPC 的几率降低了 47%（调整后 OR 为 0.53，95% CI 为 0.34 至 0.85）。无论PPC的定义如何，这一效果都很稳定。吸烟、年龄小于 45 岁、体重异常、患有多种并发症或正在接受减肥或上消化道手术的参试者所受影响最大。手术时间不超过3小时的参与者对术前物理治疗的反应最小。如果术前接受物理治疗，有多种并发症的患者更有可能缩短住院时间（调整后的MD为-3.2天，95% CI为-6.2至-0.3）。对死亡率的影响尚不确定：有强有力的证据支持术前物理治疗可预防择期腹部手术后的 PPCs。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Journal of Physiotherapy ORTHOPEDICS-REHABILITATION

CiteScore

11.40

自引率

7.40%

发文量

审稿时长

72 days

期刊介绍： The Journal of Physiotherapy is the official journal of the Australian Physiotherapy Association. It aims to publish high-quality research with a significant impact on global physiotherapy practice. The journal's vision is to lead the field in supporting clinicians to access, understand, and implement research evidence that will enhance person-centred care. In January 2008, the Journal of Physiotherapy became the first physiotherapy journal to adhere to the ICMJE requirement of registering randomized trials with a recognized Trial Registry. The journal prioritizes systematic reviews, clinical trials, economic analyses, experimental studies, qualitative studies, epidemiological studies, and observational studies. In January 2014, it also became the first core physiotherapy/physical therapy journal to provide free access to editorials and peer-reviewed original research. The Australian Physiotherapy Association extended their support for excellence in physiotherapy practice by sponsoring open access publication of all Journal of Physiotherapy content in 2016. As a result, all past, present, and future journal articles are freely accessible, and there are no author fees for publication.