Effects of preoperative physiotherapy on signs and symptoms of pulmonary collapse and infection after major abdominal surgery: secondary analysis of the LIPPSMAck-POP multicentre randomised controlled trial
Abstract Background Preoperative education and breathing exercise training by a physiotherapist minimises pulmonary complications after abdominal surgery. Effects on specific clinical outcomes such as antibiotic prescriptions, chest imaging, sputum cultures, oxygen requirements, and diagnostic codin...
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| Format: | Article |
| Language: | English |
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BMC
2021-10-01
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| Series: | Perioperative Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13741-021-00206-3 |
| _version_ | 1818741647787163648 |
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| author | I. Boden J. Reeve I. K. Robertson L. Browning E. H. Skinner L. Anderson C. Hill D. Story L. Denehy |
| author_facet | I. Boden J. Reeve I. K. Robertson L. Browning E. H. Skinner L. Anderson C. Hill D. Story L. Denehy |
| author_sort | I. Boden |
| collection | DOAJ |
| description | Abstract Background Preoperative education and breathing exercise training by a physiotherapist minimises pulmonary complications after abdominal surgery. Effects on specific clinical outcomes such as antibiotic prescriptions, chest imaging, sputum cultures, oxygen requirements, and diagnostic coding are unknown. Methods This post hoc analysis of prospectively collected data within a double-blinded, multicentre, randomised controlled trial involving 432 participants having major abdominal surgery explored effects of preoperative education and breathing exercise training with a physiotherapist on postoperative antibiotic prescriptions, hypoxemia, sputum cultures, chest imaging, auscultation, leukocytosis, pyrexia, oxygen therapy, and diagnostic coding, compared to a control group who received a booklet alone. All participants received standardised postoperative early ambulation. Outcomes were assessed daily for 14 postoperative days. Analyses were intention-to-treat using adjusted generalised multivariate linear regression. Results Preoperative physiotherapy was associated with fewer antibiotic prescriptions specific for a respiratory infection (RR 0.52; 95% CI 0.31 to 0.85, p = 0.01), less purulent sputum on the third and fourth postoperative days (RR 0.50; 95% CI 0.34 to 0.73, p = 0.01), fewer positive sputum cultures from the third to fifth postoperative day (RR 0.17; 95% CI 0.04 to 0.77, p = 0.01), and less oxygen therapy requirements (RR 0.49; 95% CI 0.31 to 0.78, p = 0.002). Treatment effects were specific to respiratory clinical coding domains. Conclusions Preoperative physiotherapy prevents postoperative pulmonary complications and is associated with the minimisation of signs and symptoms of pulmonary collapse/consolidation and airway infection and specifically results in reduced oxygen therapy requirements and antibiotic prescriptions. Trial registration ANZCTR 12613000664741 ; 19/06/2013. |
| first_indexed | 2024-12-18T01:59:57Z |
| format | Article |
| id | doaj.art-c7551ffa4fde43e0963450d6c1f69946 |
| institution | Directory Open Access Journal |
| issn | 2047-0525 |
| language | English |
| last_indexed | 2024-12-18T01:59:57Z |
| publishDate | 2021-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Perioperative Medicine |
| spelling | doaj.art-c7551ffa4fde43e0963450d6c1f699462022-12-21T21:24:47ZengBMCPerioperative Medicine2047-05252021-10-0110111110.1186/s13741-021-00206-3Effects of preoperative physiotherapy on signs and symptoms of pulmonary collapse and infection after major abdominal surgery: secondary analysis of the LIPPSMAck-POP multicentre randomised controlled trialI. Boden0J. Reeve1I. K. Robertson2L. Browning3E. H. Skinner4L. Anderson5C. Hill6D. Story7L. Denehy8Department of Physiotherapy, Launceston General HospitalSchool of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of TechnologySchool of Health Sciences, University of TasmaniaDirectorate of Community Integration, Allied Health and Service Planning, Western HealthFaculty of Medicine Nursing and Health Science, Monash UniversityPhysiotherapy Department, North Shore Hospital, Waitemata District Health BoardPhysiotherapy Department, North West Regional HospitalAnaesthesia Perioperative and Pain Medicine Unit, The University of MelbourneMelbourne School of Health Sciences, The University of MelbourneAbstract Background Preoperative education and breathing exercise training by a physiotherapist minimises pulmonary complications after abdominal surgery. Effects on specific clinical outcomes such as antibiotic prescriptions, chest imaging, sputum cultures, oxygen requirements, and diagnostic coding are unknown. Methods This post hoc analysis of prospectively collected data within a double-blinded, multicentre, randomised controlled trial involving 432 participants having major abdominal surgery explored effects of preoperative education and breathing exercise training with a physiotherapist on postoperative antibiotic prescriptions, hypoxemia, sputum cultures, chest imaging, auscultation, leukocytosis, pyrexia, oxygen therapy, and diagnostic coding, compared to a control group who received a booklet alone. All participants received standardised postoperative early ambulation. Outcomes were assessed daily for 14 postoperative days. Analyses were intention-to-treat using adjusted generalised multivariate linear regression. Results Preoperative physiotherapy was associated with fewer antibiotic prescriptions specific for a respiratory infection (RR 0.52; 95% CI 0.31 to 0.85, p = 0.01), less purulent sputum on the third and fourth postoperative days (RR 0.50; 95% CI 0.34 to 0.73, p = 0.01), fewer positive sputum cultures from the third to fifth postoperative day (RR 0.17; 95% CI 0.04 to 0.77, p = 0.01), and less oxygen therapy requirements (RR 0.49; 95% CI 0.31 to 0.78, p = 0.002). Treatment effects were specific to respiratory clinical coding domains. Conclusions Preoperative physiotherapy prevents postoperative pulmonary complications and is associated with the minimisation of signs and symptoms of pulmonary collapse/consolidation and airway infection and specifically results in reduced oxygen therapy requirements and antibiotic prescriptions. Trial registration ANZCTR 12613000664741 ; 19/06/2013.https://doi.org/10.1186/s13741-021-00206-3Pulmonary complicationsPreoperativePhysiotherapyAntibioticsOxygen therapyAbdominal surgery |
| spellingShingle | I. Boden J. Reeve I. K. Robertson L. Browning E. H. Skinner L. Anderson C. Hill D. Story L. Denehy Effects of preoperative physiotherapy on signs and symptoms of pulmonary collapse and infection after major abdominal surgery: secondary analysis of the LIPPSMAck-POP multicentre randomised controlled trial Perioperative Medicine Pulmonary complications Preoperative Physiotherapy Antibiotics Oxygen therapy Abdominal surgery |
| title | Effects of preoperative physiotherapy on signs and symptoms of pulmonary collapse and infection after major abdominal surgery: secondary analysis of the LIPPSMAck-POP multicentre randomised controlled trial |
| title_full | Effects of preoperative physiotherapy on signs and symptoms of pulmonary collapse and infection after major abdominal surgery: secondary analysis of the LIPPSMAck-POP multicentre randomised controlled trial |
| title_fullStr | Effects of preoperative physiotherapy on signs and symptoms of pulmonary collapse and infection after major abdominal surgery: secondary analysis of the LIPPSMAck-POP multicentre randomised controlled trial |
| title_full_unstemmed | Effects of preoperative physiotherapy on signs and symptoms of pulmonary collapse and infection after major abdominal surgery: secondary analysis of the LIPPSMAck-POP multicentre randomised controlled trial |
| title_short | Effects of preoperative physiotherapy on signs and symptoms of pulmonary collapse and infection after major abdominal surgery: secondary analysis of the LIPPSMAck-POP multicentre randomised controlled trial |
| title_sort | effects of preoperative physiotherapy on signs and symptoms of pulmonary collapse and infection after major abdominal surgery secondary analysis of the lippsmack pop multicentre randomised controlled trial |
| topic | Pulmonary complications Preoperative Physiotherapy Antibiotics Oxygen therapy Abdominal surgery |
| url | https://doi.org/10.1186/s13741-021-00206-3 |
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