Coughing and Deep Breathing vs. Incentive Spirometry Nursing Interventions: A Retrospective Analysis

Incentive spirometry (IS) has long been considered a standard nursing intervention to prevent postoperative pulmonary complications (PPCs). Similarly, coughing and deep breathing (CDB) is a standard intervention to promote lung expansion and secretion clearance. Studies have reported mixed results regarding the use of IS alone (IS-A) in the prevention of PPCs.

We aimed to evaluate the effectiveness of CDB alone (CDB-A) versus combined CDB and IS (CDB-IS) in preventing PPCs and 30-day readmissions among postsurgical patients without underlying pulmonary disease, while also examining IS-A as a clinically relevant comparator across postoperative outcomes.

This retrospective analysis included electronic health record data from adult inpatient surgical encounters at a tertiary academic medical center from July to December 2019 and July to December 2022. A total of 2,386 encounters were included in the primary analysis.

In the 2,386 encounters, 508 (21.3%) patients were prescribed IS-A, 1,127 (47.2%) were prescribed CDB-A, and 751 (31.5%) were prescribed CDB-IS. PPCs were rare, occurring in approximately 1% of encounters, with no significant differences between the intervention groups. After adjusting for surgery type, surgery duration, American Society of Anesthesiologists physical status classification level, physical therapy (PT) order status, Bedside Mobility Assessment Tool scores, and prior pulmonary-related diagnoses, patients prescribed CDB-A had higher odds of 30-day readmission compared with those prescribed IS-A (odds ratio, 1.28; 95% CI, 1.02-1.60; P = 0.03). No significant difference in readmissions was observed between patients prescribed CDB-IS and those prescribed IS-A. Longer hospital length of stay and absence of PT orders were independently associated with higher readmission risk.

PPCs were uncommon in the study cohort regardless of respiratory intervention type. IS-A was not associated with increased PPCs and was associated with lower readmission rates compared with CDB-A in the primary analysis, though this association was not sustained in sensitivity analyses. Findings support continued IS use with a multimodal postoperative care approach emphasizing early mobility and PT.