Preoperative physiotherapy prevents postoperative pulmonary complications after major abdominal surgery: a meta-analysis of individual patient data

Ianthe Boden; Julie Reeve; Anna Jernås; Linda Denehy; Monika Fagevik Olsén

doi:10.1016/j.jphys.2024.02.012

Preoperative physiotherapy prevents postoperative pulmonary complications after major abdominal surgery: a meta-analysis of individual patient data

J Physiother. 2024 Mar 11:S1836-9553(24)00013-4. doi: 10.1016/j.jphys.2024.02.012. Online ahead of print.

Authors

Ianthe Boden¹, Julie Reeve², Anna Jernås³, Linda Denehy⁴, Monika Fagevik Olsén⁵

Affiliations

¹ University of Tasmania, Launceston, Tasmania, Australia; Launceston General Hospital, Launceston, Australia. Electronic address: Ianthe.boden@utas.edu.au.
² School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand; Physiotherapy Department, North Shore Hospital, Auckland, New Zealand.
³ Department of Physical Therapy, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁴ Physiotherapy Department, The University of Melbourne, Melbourne, Australia; Peter McCallum Cancer Centre, Melbourne, Australia.
⁵ Department of Physical Therapy, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.

PMID: 38472053
DOI: 10.1016/j.jphys.2024.02.012

Abstract

Questions: Among patients having elective abdominal surgery, how much does preoperative physiotherapy education with breathing exercise training reduce the incidence of postoperative pulmonary complications (PPCs), hospital length of stay and 12-month mortality? How stable are the treatment effects across different PPC definitions, including pneumonia? How much do the treatment effects on PPC, hospital length of stay and mortality vary within clinically relevant subgroups?

Design: Individual participant-level meta-analysis (n = 800) from two randomised controlled trials analysed with multivariable regression.

Participants: Adults undergoing major elective abdominal surgery.

Interventions: Experimental participants received a single preoperative session with a physiotherapist within 4 weeks of surgery and educated on PPC prevention with breathing exercises and early mobilisation. They were taught breathing exercises and instructed to start them immediately on waking from surgery. The control group received no preoperative or postoperative physiotherapy, or early ambulation alone.

Outcome measures: PPC, hospital length of stay and 12-month mortality.

Results: Participants who received preoperative physiotherapy had 47% lower odds of developing a PPC (adjusted OR 0.53, 95% CI 0.34 to 0.85). This effect was stable regardless of PPC definition. Effects were greatest in participants who smoked, were aged ≤ 45 years, had abnormal body weight, had multiple comorbidities, or were undergoing bariatric or upper gastrointestinal surgery. Participants having operations ≤ 3 hours in duration were least responsive to preoperative physiotherapy. Participants with multiple comorbidities were more likely to have a shorter hospital stay if provided with preoperative physiotherapy (adjusted MD -3.2 days, 95% CI -6.2 to -0.3). Effects on mortality were uncertain.

Conclusion: There is strong evidence to support preoperative physiotherapy in preventing PPCs after elective abdominal surgery.

Keywords: Abdominal surgery; Meta-analysis; Physical therapy; Preoperative; Pulmonary complications.