Does physiotherapy reduce the incidence of postoperative pulmonary complications following pulmonary resection via open thoracotomy? A preliminary randomised single-blind clinical trial

• Published in: European journal of cardio-thoracic surgery 2010-05, Vol.37 (5), p.1158-1166
• Main Authors: Reeve, Julie C., Nicol, Kristine, Stiller, Kathy, McPherson, Kathryn M., Birch, Paul, Gordon, Ian R., Denehy, Linda
• Format: Article
• Language: English
• Subjects: Aged; Female; Forced Expiratory Volume; Humans; Length of Stay - statistics & numerical data; Lung Diseases - etiology; Lung Diseases - prevention & control; Male; Physical Therapy Modalities; Physiotherapy; Pneumonectomy - adverse effects; Postoperative Care - methods; Postoperative complications; Prospective Studies; Pulmonary Disease, Chronic Obstructive - complications; Risk Factors; Single-Blind Method; Thoracotomy; Thoracotomy - adverse effects
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2009.12.011

Objective: This study investigates whether targeted postoperative respiratory physiotherapy decreased the incidence of postoperative pulmonary complications and length of stay for patients undergoing elective pulmonary resection via open thoracotomy. Methods: Seventy-six patients participated in a prospective, single-blind, parallel-group, randomised trial with concealed allocation, assessor blinding and intention-to-treat analysis. Treatment group participants received daily respiratory physiotherapy interventions until discharge. Control group participants received standard medical/nursing care involving a clinical pathway. The presence of postoperative pulmonary complications was assessed on a daily basis during hospitalisation using a standardised diagnostic tool. Length of stay was recorded. Results: Postoperative pulmonary complications developed in two participants (4.8%) in the treatment group and in one participant (2.9%) in the control group; the difference (treatment minus control) was 1.8% (95% confidence interval (CI) −10.6% to 13.1%) (p = 1.00). No significant difference was found between groups for length of stay (treatment group, median 6.0 days; control group 6.0 days) (p = 0.87). A preoperative forced expiratory volume in 1 s of 1.5 l or less (p = 0.005) and a history of chronic obstructive pulmonary disease (p = 0.008) were associated with a greater number of criteria for a postoperative pulmonary complication being met. Conclusions: In this patient population, given the low incidence of postoperative pulmonary complications, targeted respiratory physiotherapy may not be required in addition to standard care involving a clinical pathway following pulmonary resection via open thoracotomy. These results should be extrapolated with caution to those patients undergoing pulmonary resection with poor preoperative lung function.