LIPPSMAck POP
Trial question
What is the role of preoperative physiotherapy in the prevention of respiratory complications in patients listed for elective upper abdominal surgery?
Study design
Multi-center
Double blinded
RCT
Population
Characteristics of study participants
38.0% female
62.0% male
N = 432
432 patients (166 female, 266 male).
Inclusion criteria: adult patients aged ≥ 18 years who were within 6 weeks of elective major open upper abdominal surgery.
Key exclusion criteria: current hospital inpatients; need for organ transplants; need for abdominal hernia repair; unable to ambulate for > 1 minute; unable to participate in a single physiotherapy preoperative session within 6 weeks of surgery.
Interventions
N=218 preoperative physiotherapy (30-minute physiotherapy education and breathing exercise training session plus information booklet).
N=214 information booklet (receipt of information booklet alone).
Primary outcome
Rate of postoperative pulmonary complications within 14 postoperative hospital days
12%
27%
27.0 %
20.3 %
13.5 %
6.8 %
0.0 %
Preoperative
physiotherapy
Information
booklet
Significant
decrease ▼
NNT = 6
Significant decrease in the rate of postoperative pulmonary complications within 14 postoperative hospital days (12% vs. 27%; aHR 0.48, 95% CI 0.3 to 0.75).
Secondary outcomes
Significant decrease in pneumonia (8% vs. 20%; aHR 0.45, 95% CI 0.26 to 0.78).
No significant difference in length of hospital stay (8 days vs. 9 days; aOR 0.85, 95% CI 0.61 to 1.19).
No significant difference in time from operation to ambulation > 1 min (23 hours vs. 22 hours; aHR 1.03, 95% CI 0.82 to 1.3).
Safety outcomes
No significant differences in any complications at 6 weeks, death, venous thromboembolic events, gastrointestinal complications, wound infection, and fatigue.
Significant difference in cardiac complications (5% vs. 2%) and respiratory complications (4% vs. 9%).
Conclusion
In adult patients aged ≥ 18 years who were within 6 weeks of elective major open upper abdominal surgery, preoperative physiotherapy was superior to information booklet with respect to the rate of postoperative pulmonary complications within 14 postoperative hospital days.
Reference
Ianthe Boden, Elizabeth H Skinner, Laura Browning et al. Preoperative physiotherapy for the prevention of respiratory complications after upper abdominal surgery: pragmatic, double blinded, multicentre randomised controlled trial. BMJ. 2018 Jan 24;360:j5916.
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