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Preoperative physiotherapy for the prevention of respiratory complications after upper abdominal surgery: pragmatic, double blinded, multicentre randomised controlled trial

Ianthe BodenElizabeth H Skinner, Laura Browning, et al

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.j5916 (Published 24 January 2018)

Cite this as: BMJ 2018;360:j5916


Objective 目的

To assess the efficacy of a single preoperative physiotherapy session to reduce postoperative pulmonary complications (PPCs) after upper abdominal surgery.


Design 设计

Prospective, pragmatic, multicentre, patient and assessor blinded, parallel group, randomised placebo controlled superiority trial.


Setting 场景

Multidisciplinary preadmission clinics at three tertiary public hospitals in Australia and New Zealand.


Participants 研究对象

441 adults aged 18 years or older who were within six weeks of elective major open upper abdominal surgery were randomly assigned through concealed allocation to receive either an information booklet (n=219; control) or preoperative physiotherapy (n=222; intervention) and followed for 12 months. 432 completed the trial.

441名18岁以上成年患者拟在6周内进行择期上腹部开腹手术。患者在分配隐藏的情况下被随机分为接到说明书(n = 219;对照组)或接受术前理疗(n = 222;干预组),随访12个月。432名患者完成试验。

Interventions 干预

Preoperatively, participants received an information booklet (control) or an additional 30 minute physiotherapy education and breathing exercise training session (intervention). Education focused on PPCs and their prevention through early ambulation and self directed breathing exercises to be initiated immediately on regaining consciousness after surgery. Postoperatively, all participants received standardised early ambulation, and no additional respiratory physiotherapy was provided.


Main outcome measures 主要预后指标

The primary outcome was a PPC within 14 postoperative hospital days assessed daily using the Melbourne group score. Secondary outcomes were hospital acquired pneumonia, length of hospital stay, utilisation of intensive care unit services, and hospital costs. Patient reported health related quality of life, physical function, and post-discharge complications were measured at six weeks, and all cause mortality was measured to 12 months.


Results 结果

The incidence of PPCs within 14 postoperative hospital days, including hospital acquired pneumonia, was halved (adjusted hazard ratio 0.48, 95% confidence interval 0.30 to 0.75, P=0.001) in the intervention group compared with the control group, with an absolute risk reduction of 15% (95% confidence interval 7% to 22%) and a number needed to treat of 7 (95% confidence interval 5 to 14). No significant differences in other secondary outcomes were detected.

与对照组相比,干预组患者术后14天内PPCs(包括医院获得性肺炎)发生率下降一半(校正后风险比0.48, 95% 可信区间 0.30 - 0.75, P=0.001),绝对危险度降低15%(95% 可信区间 7% - 22%),需治数为7 (95% 可信区间 5 - 14)。其他次要预后指标无显著差异。 


Conclusion 结论

In a general population of patients listed for elective upper abdominal surgery, a 30 minute preoperative physiotherapy session provided within existing hospital multidisciplinary preadmission clinics halves the incidence of PPCs and specifically hospital acquired pneumonia. Further research is required to investigate benefits to mortality and length of stay.


Trial registration 试验注册

Australian New Zealand Clinical Trials Registry ANZCTR 12613000664741.


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