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Prevention of respiratory complications after abdominal surgery: a randomised clinical trial
J C Hall1, R A Tarala, J Tapper
1University Department of Surgery, Royal Perth Hospital, Australia.
Insights
Deep breathing exercises for low-risk patients and incentive spirometry for high-risk patients are most effective for preventing respiratory complications after abdominal surgery, considering resource use.
Area of Science:
- Medical Research
- Surgical Care
- Pulmonary Medicine
Background:
- Post-abdominal surgery respiratory complications pose a significant risk.
- Prophylactic respiratory therapies aim to mitigate these risks.
Purpose of the Study:
- To compare incentive spirometry (IS) with a tailored approach: deep breathing exercises (DBE) for low-risk patients and IS plus physiotherapy (PT) for high-risk patients.
- To evaluate the effectiveness and resource implications of different prophylactic respiratory strategies.
Main Methods:
- Stratified randomized trial involving 456 patients undergoing abdominal surgery.
- Low-risk patients: <60 years, ASA classification I.
- Respiratory complications defined by clinical signs, fever, and chest imaging/sputum analysis.
Main Results:
- No significant difference in respiratory complication rates between global IS (15%) and the tailored approach (12%; P=0.40).
- Tailored approach with DBE for low-risk and IS for high-risk patients required similar staff time compared to global IS.
- Adding physiotherapy for high-risk patients in the tailored group increased staff time by 30 minutes per patient.
Conclusions:
- The most resource-efficient strategy for preventing post-abdominal surgery respiratory complications is DBE for low-risk patients and IS for high-risk patients.
- This tailored approach balances efficacy with optimal resource utilization.
Objective:
To evaluate the prevention of respiratory complications after abdominal surgery by a comparison of a global policy of incentive spirometry with a regimen consisting of deep breathing exercises for low risk patients and incentive spirometry plus physiotherapy for high risk patients.
Design:
Stratified randomised trial.
Setting:
General surgical service of an urban teaching hospital.
Patients:
456 patients undergoing abdominal surgery. Patients less than 60 years of age with an American Society of Anesthesia classification of 1 were considered to be at low risk.
Outcome Measures:
Respiratory complications were defined as clinical features consistent with collapse or consolidation, a temperature above 38 degrees C, plus either confirmatory chest radiology or positive results on sputum microbiology. We also recorded the time that staff devoted to prophylactic respiratory therapy.
Results:
There was good baseline equivalence between the groups. The incidence of respiratory complications was 15% (35/231) for patients in the incentive spirometry group and 12% (28/225) for patients in the mixed therapy group (P = 0.40; 95% confidence interval -3.6% to 9.0%). It required similar amounts of staff time to provide incentive spirometry and deep breathing exercises for low risk patients. The inclusion of physiotherapy for high risk patients, however, resulted in the utilisation of an extra 30 minutes of staff time per patient.
Conclusions:
When the use of resources is taken into account, the most efficient regimen of prophylaxis against respiratory complications after abdominal surgery is deep breathing exercises for low risk patients and incentive spirometry for high risk patients.