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Video-assisted thoracoscopic lobectomy: which patients require postoperative physiotherapy?

P Agostini1, S T Lugg2, K Adams3

  • 1Department of Thoracic Surgery, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK; School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK; Faculty of Education, Health and Wellbeing, University of Wolverhampton, Walsall Campus, Gorway Rd, Walsall WS1 3EZ, UK.

Physiotherapy
|April 20, 2019
PubMed
Summary

Physiotherapy is crucial after video-assisted thoracoscopic surgery (VATS) lobectomy for mobility and lung function. Early assessment identifies patients benefiting most from interventions, improving recovery and reducing hospital stay.

Keywords:
AtelectasisPhysiotherapyPneumoniaRehabilitationRisk factorsVATS

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Area of Science:

  • Thoracic Surgery
  • Pulmonary Rehabilitation
  • Postoperative Care

Background:

  • Physiotherapy is recommended post-thoracic surgery to improve lung volume, secretion clearance, and mobility.
  • Provision of physiotherapy is inconsistent after minimally invasive video-assisted thoracoscopic surgery (VATS).

Purpose of the Study:

  • To determine the frequency of issues treatable by physiotherapy after VATS lobectomy.
  • To identify patient factors associated with the need for physiotherapy.

Main Methods:

  • Prospective observational study of 285 cancer patients undergoing VATS lobectomy (2012-2016).
  • Physiotherapy assessment on postoperative day one (POD1) identified issues and initiated treatment.
  • Outcomes included postoperative pulmonary complications (PPCs), hospital, and high dependency unit (HDU) length of stay (LOS).

Main Results:

  • 73% of patients received physiotherapy for mobility, 23% for lung volume, and 8% for sputum clearance.
  • Patients not receiving physiotherapy had significantly shorter hospital/HDU LOS (P<0.001).
  • COPD, BMI, preoperative mobility, and age were associated with issues amenable to physiotherapy (P=0.013).

Conclusions:

  • A significant proportion of patients undergoing VATS lobectomy have issues treatable by physiotherapy.
  • Routine physiotherapy assessment post-VATS lobectomy is recommended for early identification of needs.
  • Screening for COPD, BMI, preoperative mobility, and age can help identify patients who may benefit from physiotherapy.