Preoperative Physiotherapy Prevents Postoperative Pulmonary Complications After Major Abdominal Surgery: A Meta-Analysis of Individual Patient Data

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aut.relation.endpage223
aut.relation.issue3
aut.relation.journalJournal of Physiotherapy
aut.relation.startpage216
aut.relation.volume70
dc.contributor.authorBoden, Ianthe
dc.contributor.authorReeve, Julie
dc.contributor.authorJernås, Anna
dc.contributor.authorDenehy, Linda
dc.contributor.authorFagevik Olsén, Monika
dc.date.accessioned2024-11-12T01:47:17Z
dc.date.available2024-11-12T01:47:17Z
dc.date.issued2024-03-11
dc.description.abstractQUESTIONS: 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.
dc.identifier.citationJournal of Physiotherapy, ISSN: 1836-9553 (Print); 1836-9561 (Online), Elsevier, 70(3), 216-223. doi: 10.1016/j.jphys.2024.02.012
dc.identifier.doi10.1016/j.jphys.2024.02.012
dc.identifier.issn1836-9553
dc.identifier.issn1836-9561
dc.identifier.urihttp://hdl.handle.net/10292/18291
dc.languageeng
dc.publisherElsevier
dc.relation.urihttps://www.clinicalkey.com.au/#!/content/playContent/1-s2.0-S1836955324000134
dc.rights© 2024 Australian Physiotherapy Association. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
dc.rights.accessrightsOpenAccess
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subjectAbdominal surgery
dc.subjectMeta-analysis
dc.subjectPhysical therapy
dc.subjectPreoperative
dc.subjectPulmonary complications
dc.subjectAbdominal surgery
dc.subjectMeta-analysis
dc.subjectPhysical therapy
dc.subjectPreoperative
dc.subjectPulmonary complications
dc.subject4201 Allied Health and Rehabilitation Science
dc.subject32 Biomedical and Clinical Sciences
dc.subject3202 Clinical Sciences
dc.subject42 Health Sciences
dc.subjectClinical Research
dc.subjectClinical Trials and Supportive Activities
dc.subjectPatient Safety
dc.subjectLung
dc.subjectPrevention
dc.subject6.4 Surgery
dc.subject3 Good Health and Well Being
dc.subject.meshFemale
dc.subject.meshHumans
dc.subject.meshMale
dc.subject.meshMiddle Aged
dc.subject.meshAbdomen
dc.subject.meshBreathing Exercises
dc.subject.meshElective Surgical Procedures
dc.subject.meshLength of Stay
dc.subject.meshLung Diseases
dc.subject.meshPhysical Therapy Modalities
dc.subject.meshPostoperative Complications
dc.subject.meshPreoperative Care
dc.subject.meshRandomized Controlled Trials as Topic
dc.subject.meshAdult
dc.subject.meshAbdomen
dc.subject.meshHumans
dc.subject.meshLung Diseases
dc.subject.meshPostoperative Complications
dc.subject.meshBreathing Exercises
dc.subject.meshLength of Stay
dc.subject.meshPreoperative Care
dc.subject.meshAdult
dc.subject.meshMiddle Aged
dc.subject.meshFemale
dc.subject.meshMale
dc.subject.meshPhysical Therapy Modalities
dc.subject.meshRandomized Controlled Trials as Topic
dc.subject.meshElective Surgical Procedures
dc.subject.meshFemale
dc.subject.meshHumans
dc.subject.meshMale
dc.subject.meshMiddle Aged
dc.subject.meshAbdomen
dc.subject.meshBreathing Exercises
dc.subject.meshElective Surgical Procedures
dc.subject.meshLength of Stay
dc.subject.meshLung Diseases
dc.subject.meshPhysical Therapy Modalities
dc.subject.meshPostoperative Complications
dc.subject.meshPreoperative Care
dc.subject.meshRandomized Controlled Trials as Topic
dc.subject.meshAdult
dc.titlePreoperative Physiotherapy Prevents Postoperative Pulmonary Complications After Major Abdominal Surgery: A Meta-Analysis of Individual Patient Data
dc.typeJournal Article
pubs.elements-id541911
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