What is the clinical evidence from this study?

Study design: RCT. Population: Major abdominal surgery (n=432). Intervention: Preoperative physiotherapy (education and breathing exercise training) vs. Information booklet alone. Primary outcome: Antibiotic prescriptions specific for a respiratory infection (RR 0.52, 95% CI 0.31 to 0.85, p=0.01).

October 25, 2021Perioperative Medicine11 citationsOpen Access

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

IBIanthe BodenUniversity of Tasmania JRJulie ReeveAuckland University of Technology IRIain RobertsonSwansea University

Key Result

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.

Study Design

Type

RCT (n=432)

Blinding

Double-blinded

Randomization

Block randomised without stratification via concealed allocation

Multicenter

Yes

Structured PICO

Does preoperative physiotherapy reduce signs and symptoms of pulmonary collapse and infection in patients having major abdominal surgery?

Population

432 adults aged 52-75 undergoing elective major abdominal surgery, followed for 14 postoperative days.

Intervention

Preoperative education and breathing exercise training with a physiotherapist

Comparator

Booklet alone (both groups received standardised postoperative early ambulation)

Outcome

Postoperative antibiotic prescriptions, hypoxemia, sputum cultures, chest imaging, auscultation, leukocytosis, pyrexia, oxygen therapy, and diagnostic coding assessed daily for 14 postoperative days

Preoperative physiotherapy reduces postoperative oxygen therapy requirements and antibiotic prescriptions for respiratory infections in patients undergoing major abdominal surgery.

Main Result

Relative Risk: 0.52 (95% CI 0.31–0.85)

Absolute Event Rate: 13% vs 25%

p-value: p=0.01

Limitations

Performance of breathing exercises was not directly measured, limiting certainty of the mechanism of effect.
Post hoc exploratory secondary analyses were not pre-specified within the original trial registration.
Clinical coding under-reports true event rates and lacks reliability.
Low event rates for some criteria limited statistical power for secondary endpoints.

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.

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