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Breathing Training Prevents Post-Op Pneumonia

The incidence of serious lung complications after major abdominal surgery was halved when patients saw a physiotherapist before their operation, learned breathing exercises, and began to perform these as soon as they woke up from the surgery, according to a trial published in ThntBMJ. 

Researchers wrote that their findings “are directly applicable to the tens of millions of patients listed for elective major abdominal surgery worldwide,” and that the breathing exercises “could be considered for all patients awaiting upper abdominal surgery.” One in three people develop pneumonia or other lung infections after major surgery. 

“It is very important for patients who are having abdominal surgery to learn breathing exercises,” says study author Ianthe Boden, titled cardiorespiratory APAM, PhD candidate, MSc, BAppSc, manager of the surgery research group and clinical lead in the Cardiorespiratory Physiotherapy, Physiotherapy Department, Allied Health Services, Tasmanian Health Services – North, Launceston General Hospital in Launceston, Tasmania. 

Although upper abdominal surgery is the most common major surgical procedure that is performed in developed countries, it does carry a risk of serious pulmonary complications like pneumonia and lung collapse, both of which are linked to high health care costs as well as high mortality. 

“We know that around one in three people having abdominal surgery will get some type of chest infection, including pneumonia, or a breathing problem in the hospital following surgery,” says Dr. Boden. “These patients are more likely to spend longer in the hospital, require time in ICU and, unfortunately, much more likely to die.”

However, he says, the rate of these serious complications can be halved. “Our large international multicenter randomized controlled trial found that by simply meeting a physiotherapist sometime in the two weeks before surgery can make a huge difference to how a patient recovers after surgery,” he says.

At a preoperative meeting with a patient, the physiotherapist educates the patient about the risk of breathing complications and pneumonia and teaches her to do special deep breathing exercises designed to re-expand the lungs. “The exercises prevent sputum and bacteria from stagnating following surgery,” Dr. Boden says. “The patient is taught some memory cues to remember do to these exercises as soon as they wake up from the operation and then continue them 20 times every hour in the first two days after surgery.” 

The study focused on 441 adults who had had elective upper abdominal surgery in the previous six weeks. They were assigned to either receive an information booklet or have a half-hour face to face breathing exercise training session with a physiotherapist.  After their surgery, the patients were assessed for two weeks for signs of pulmonary complications. The researchers found that in the intervention group versus the control group, the rate of pulmonary complications within 14 days of surgery was halved. There was an absolute risk reduction of 15%.

The main risks of abdominal surgery are varied. “A breathing complication is the most common postoperative complication,” says Dr. Boden. “Other common ones are paralytic ileus and wound infection. Less common are pulmonary emboli and cardiovascular events, which occur in less than 1% of cases.” 

The researchers found that when the patient was taught the breathing exercises by an experienced physiotherapist, the risk of chest infections was even lower, Dr. Boden said. “Chest infections were reduced and the death rates were also significantly reduced and the time spent in hospital was less,” he says. “This means that the quality of how we educate and teach can be quite important.”

Last updated on 9/26/19.

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