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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
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.
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.
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