Preoperative physiotherapy for the prevention of respiratory complications after upper abdominal surgery: pragmatic, double blinded, multicentre randomised controlled trial
| Autor: | Lesley Anderson, David A Story, Elizabeth H Skinner, Ianthe Boden, Julie Reeve, Laura Browning, Cat Hill, Linda Denehy, Iain K Robertson |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Respiratory Tract Diseases Population Preoperative care law.invention 03 medical and health sciences Postoperative Complications 0302 clinical medicine Double-Blind Method Randomized controlled trial law Abdomen Preoperative Care medicine Humans Prospective Studies 030212 general & internal medicine education Physical Therapy Modalities Aged education.field_of_study business.industry Research Australia General Medicine Middle Aged Intensive care unit Clinical trial Elective Surgical Procedures Cardiothoracic surgery 030220 oncology & carcinogenesis Physical therapy Number needed to treat Female business Elective Surgical Procedure New Zealand |
| Zdroj: | The BMJ |
| ISSN: | 1756-1833 0959-8138 |
| DOI: | 10.1136/bmj.j5916 |
| Popis: | Objective To assess the efficacy of a single preoperative physiotherapy session to reduce postoperative pulmonary complications (PPCs) after upper abdominal surgery. Design Prospective, pragmatic, multicentre, patient and assessor blinded, parallel group, randomised placebo controlled superiority trial. Setting Multidisciplinary preadmission clinics at three tertiary public hospitals in Australia and New Zealand. Participants 441 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. Interventions Preoperatively, 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 measures The 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. Results 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 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. Conclusion In 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 investigate benefits to mortality and length of stay. Trial registration Australian New Zealand Clinical Trials Registry ANZCTR 12613000664741. |
| Databáze: | OpenAIRE |
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