Key result
Coughing and deep breathing alone is linked to ~28% higher 30-day readmissions vs incentive spirometry.
Why the study?
Studies have reported mixed results regarding the use of incentive spirometry alone in preventing postoperative pulmonary complications, and the comparative effectiveness of coughing and deep breathing alone, incentive spirometry alone, and both combined among postsurgical patients without underlying pulmonary disease required evaluation.
Does coughing and deep breathing alone or combined with incentive spirometry reduce postoperative pulmonary complications and 30-day readmissions compared to incentive spirometry alone in postsurgical patients without underlying pulmonary disease?
Observational (n=2,386)
No
Does coughing and deep breathing alone or combined with incentive spirometry reduce postoperative pulmonary complications and 30-day readmissions compared to incentive spirometry alone in postsurgical patients without underlying pulmonary disease?
In postsurgical adults without underlying pulmonary disease, postoperative pulmonary complications were rare (~1%) across all respiratory interventions, and incentive spirometry alone was associated with lower 30-day readmission odds compared to coughing and deep breathing alone in the primary analysis.
Association of incentive spirometry with lower readmission odds is hypothesis-generating; should not yet change practice.
BACKGROUND: Incentive spirometry (IS) has long been considered a standard nursing intervention to prevent postoperative pulmonary complications (PPCs). Similarly, coughing and deep breathing (CDB) is a standard intervention to promote lung expansion and secretion clearance. Studies have reported mixed results regarding the use of IS alone (IS-A) in the prevention of PPCs. PURPOSE: We aimed to evaluate the effectiveness of CDB alone (CDB-A) versus combined CDB and IS (CDB-IS) in preventing PPCs and 30-day readmissions among postsurgical patients without underlying pulmonary disease, while also examining IS-A as a clinically relevant comparator across postoperative outcomes. METHODS: This retrospective analysis included electronic health record data from adult inpatient surgical encounters at a tertiary academic medical center from July to December 2019 and July to December 2022. A total of 2,386 encounters were included in the primary analysis. RESULTS: In the 2,386 encounters, 508 (21.3%) patients were prescribed IS-A, 1,127 (47.2%) were prescribed CDB-A, and 751 (31.5%) were prescribed CDB-IS. PPCs were rare, occurring in approximately 1% of encounters, with no significant differences between the intervention groups. After adjusting for surgery type, surgery duration, American Society of Anesthesiologists physical status classification level, physical therapy (PT) order status, Bedside Mobility Assessment Tool scores, and prior pulmonary-related diagnoses, patients prescribed CDB-A had higher odds of 30-day readmission compared with those prescribed IS-A (odds ratio, 1.28; 95% CI, 1.02-1.60; P = 0.03). No significant difference in readmissions was observed between patients prescribed CDB-IS and those prescribed IS-A. Longer hospital length of stay and absence of PT orders were independently associated with higher readmission risk. CONCLUSIONS: PPCs were uncommon in the study cohort regardless of respiratory intervention type. IS-A was not associated with increased PPCs and was associated with lower readmission rates compared with CDB-A in the primary analysis, though this association was not sustained in sensitivity analyses. Findings support continued IS use with a multimodal postoperative care approach emphasizing early mobility and PT.
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Jones et al. (2026) conducted an observational in Postsurgical status without underlying pulmonary disease (n=2,386). Coughing and deep breathing alone (CDB-A) or combined with incentive spirometry (CDB-IS) vs. Incentive spirometry alone (IS-A) was evaluated on Postoperative pulmonary complications (PPCs) and 30-day readmissions (OR 1.28, 95% CI 1.02-1.60, p=0.03). Coughing and deep breathing alone had higher 30-day readmission odds vs incentive spirometry alone (OR 1.28; 95% CI 1.02-1.60; P=0.03), while postoperative pulmonary complications were rare (~1%).
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