Preoperative physiotherapy reduced antibiotic prescriptions specific for a respiratory infection (RR 0.52) and oxygen therapy requirements (RR 0.49) compared to a booklet alone in patients having major abdominal surgery.
RCT (n=432)
Double-blinded
Block randomised without stratification via concealed allocation
Yes
Does preoperative physiotherapy reduce signs and symptoms of pulmonary collapse and infection in patients having major abdominal surgery?
Preoperative physiotherapy reduces postoperative oxygen therapy requirements and antibiotic prescriptions for respiratory infections in patients undergoing major abdominal surgery.
Relative Risk: 0.52 (95% CI 0.31–0.85)
Absolute Event Rate: 13% vs 25%
p-value: p=0.01
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.
Boden et al. (Mon,) conducted a rct in Major abdominal surgery (n=432). Preoperative physiotherapy (education and breathing exercise training) vs. Information booklet alone was evaluated on Antibiotic prescriptions specific for a respiratory infection (RR 0.52, 95% CI 0.31 to 0.85, p=0.01). Preoperative physiotherapy reduced antibiotic prescriptions specific for a respiratory infection (RR 0.52) and oxygen therapy requirements (RR 0.49) compared to a booklet alone in patients having major abdominal surgery.