Current Practice of Targeted Breathing Exercises After Abdominal and Cardiothoracic Surgery: A National Multicentre Observational Study

Abstract

Objectives: To describe the timing and type of the first targeted breathing exercises after abdominal and cardiothoracic surgery, and to identify factors associated with early initiation (Commencement within three hours after arrival to a postoperative ward).

Design: Multicentre observational study. Methods: In 18 hospitals in Sweden, the start time and type of targeted breathing exercises were recorded in consecutive series of patients who underwent abdominal or cardiothoracic surgery. Demographic data were retrieved from hospital records. Patients were divided into seven groups based on the category of surgery.

Results: In total, 1492 patients were included in this study; of these, 1128 (76%) performed some form of targeted breathing exercise after surgery. Targeted breathing exercises commenced a median of 3.63 hours (interquartile range 1.58 to 11.75 hours) after arrival on a postoperative ward, with earlier commencement after minor abdominal surgery and later commencement after major abdominal surgery (P < 0.001). Most patients who performed targeted breathing exercises used positive expiratory pressure (n = 968/1492, 65%) or deep breathing without any devices (n = 207/1492, 14%). The odds of initiating breathing exercises within the first 3 hours after arrival on a postoperative ward were higher if a patient underwent pulmonary or abdominal surgery [odds ratio (OR) > 2.04; P < 0.001], or had intravenous analgesia (OR 1.50, 95% CI 1.05 to 2.14; P = 0.026). The odds were lower (OR 0.43, 95% CI 0.21 to 0.88; P = 0.021) for patients who arrived on the postoperative ward in the evening/night or for patients who had undergone laparoscopic surgery (OR 0.63, 0.43-0.92, p=0.018).

Conclusion: The majority (76%) of patients undergoing abdominal or cardiothoracic surgery performed some form of targeted breathing exercise, starting a median of 3.63 hours after arrival on a postoperative ward. Trial registration: “FoU in Sweden” (Research and Development in Sweden) ID: 275357 and Clinical Trials NCT04729634.

Contribution of the Paper: • To the authors’ knowledge, this is the first study to survey national clinical practice regarding the use of targeted breathing exercises during the first 24 hours after abdominal or cardiothoracic surgery. • Baseline data from this study can be used as comparative material for other countries.