The prevention of pulmonary complications after upper abdominal surgery in patients with noncompromised pulmonary status. The effect of physical therapy on respiratory complications following cardiac valve surgery. Physical conditioning and mental stress reduction - a randomised trial in patients undergoing cardiac surgery Pulmonary function and physical performance outcomes with preoperative physical therapy in upper abdominal surgery: a randomized controlled trial The effectiveness of incentive spirometry with physical therapy for high-risk patients after coronary artery bypass surgery. Influence of incentive spirometry on pulmonary volumes after laparotomy. Preoperative smoking habits and postoperative pulmonary complications. Preoperative inspiratory muscle training to prevent postoperative pulmonary complications in patients undergoing esophageal resection (PREPARE study): study protocol for a randomized controlled trial Incidence and hospital stay for cardiac and pulmonary complications after abdominal surgery Early postoperative 30 degrees lateral positioning after coronary artery surgery: influence on cardiac output. Effectiveness of pulmonary artery catheters in aortic surgery: a randomized trial. Preoperative physiotherapy in prevention of pulmonary complications in pediatric cardiac surgery. The Effect of Preoperative Exercise on Total Knee Replacement Outcomes Association between cardiac and noncardiac complications in patients undergoing noncardiac surgery: outcomes and effects on length of stay. Prophylactic nasal continuous positive airway pressure after major vascular surgery: results of a prospective randomized trial Efficacy of breathing and coughing exercises in the prevention of pulmonary complications after coronary artery surgery. Are maximal inspiratory breathing exercises or incentive spirometry better than early mobilization after cardiopulmonary bypass? Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery: a randomized clinical trial. Etiology, incidence, and prognosis of renal failure following cardiac operations. Results of a prospective analysis of 500 consecutive patients. Short-Term Respiratory Physical Therapy Treatment in the PACU and Influence on Postoperative Lung Function in Obese Adults Preoperative exercise training prevents functional decline after lung resection surgery: a randomized, single-blind controlled trial Morbidity and Mortality Following Breast Cancer Surgery in Women: National Benchmarks for Standards of Care Does removal of deep breathing exercises from a physiotherapy program including pre-operative education and early mobilisation after cardiac surgery alter patient outcomes?
Controversy exists regarding the routine use of breathing exercises in the prevention of pulmonary complications after upper abdominal surgery . We prospect ively r and omized 153 patients who had noncompromised pulmonary status ; the control group ( 84 patients ) engaged in no breathing exercises , and the respiratory therapy group ( 69 patients ) engaged in preoperative and postoperative breathing exercises supervised by the physical therapist .  Postoperative pulmonary complications were classified using criteria derived from chest roentgenograms , arterial blood gas sample s , and temperature registration . The incidences of postoperative complications in the treatment group and in the control groups were 19 % and 60 % , respectively . In the present study , preoperative lung function tests had no additional or predictive value . We advise preoperative and postoperative breathing exercises as a prophylactic treatment in all patients scheduled for upper abdominal surgery STUDY OBJECTIVE To determine whether higher personnel intensive chest physical therapy can prevent the atelectasis that routinely follows cardiac valve surgery . DESIGN R and omized , controlled trial . SETTING Tertiary care hospital . PATIENTS Seventy-eight patients undergoing elective cardiac valve surgery between October 1991 and April 1993 were enrolled . INTERVENTIONS Patients were r and omized in an unmasked fashion to receive early mobilization and sustained maximal inflations ( lower-intensity treatment ) or to receive early mobilization , sustained maximal inflations , and single-h and ed percussions ( higher-intensity treatment . ) MEASUREMENTS AND RESULTS Clinical efficacy was determined by extent of atelectasis , length of ICU stay , total length of hospital stay , and personnel costs . The extent of postoperative atelectasis was similar in both groups on the fifth postoperative day . Postoperative values of FVC and FEV1 were reduced to a similar extent in both groups . Hospital stays and ICU stays were similar regardless of treatment . Physical therapy costs were highest in the higher-intensity therapy group . CONCLUSIONS Postoperative respiratory dysfunction is common but does not usually cause significant morbidity or prolong hospital stay . The routine prescription of high-intensity physical therapy does not improve patient outcomes but does add significantly to patient costs Background Preoperative anxiety and physical unfitness have been shown to have adverse effects on recovery from cardiac surgery . This study involving cardiac surgery patients was primarily aim ed at assessing the feasibility of delivering physical conditioning and stress reduction programs within the public hospital setting . Secondary aims were to evaluate the effect of these programs on quality of life ( QOL ) , rates of postoperative atrial fibrillation ( AF ) and length of stay ( LOS ) in hospital . Methods Elective patients scheduled for coronary artery bypass graft and /or valve surgery at a public hospital in Melbourne , Australia were enrolled . Patients were r and omized to receive either holistic therapy ( HT ) or usual care ( UC ) . HT consisted of a series of light physical exercise sessions together with a mental stress reduction program administered in an outpatient setting for the first two weeks after placement on the waiting list for surgery . A self-administered SF-36 question naire was used to measure QOL and hospital records to collect data on LOS and rate of postoperative AF . Results The study population comprised 117 patients of whom 60 received HT and 57 received UC . Both programs were able to be delivered within the hospital setting but ongoing therapy beyond the two week duration of the program was not carried out due to long waiting periods and insufficient re sources . HT , as delivered in this study , compared to UC did not result in significant changes in QOL , LOS or AF incidence . Conclusions Preoperative holistic therapy can be delivered in the hospital setting , although two weeks is insufficient to provide benefits beyond usual care on QOL , LOS or postoperative AF . Further research is now required to determine whether a similar program of longer duration , or targeted to high risk patients can provide measurable benefits .Trial registration This trial was conducted as part of a larger study and according to the principles contained in the CONSORT statement 2001 Objective : Investigation of the effects of preoperative physical therapy on pulmonary function and physical performance before and after upper abdominal surgery . Design : Non-blind r and omized controlled trial . Setting : Tertiary public hospital and private university , São Paulo state , Brazil . Subjects : Thirty-two patients undergoing abdominal surgery . Interventions : Patients were r and omly assigned to receive physical therapy , with respiratory and global exercises , 2–3 weeks before surgery ( treatment group ; n = 16 ) or await operation without engaging in practicing ( control group ; n = 16 ) . After surgery , a physical therapy protocol was administered to all subjects until the seventh postoperative day . Main measures : Pulmonary function outcome variables were inspiratory and expiratory strength , respiratory muscle endurance and spirometry , and physical performance outcome variables were the functional independence measure and 6-minute walk test distance . Any postoperative pulmonary complications were recorded . Results : There were no between-group differences at r and omization . In the preoperative period , patients in the intervention group had higher inspiratory strength and respiratory muscle endurance than controls ( 88 cmH2O versus 64 cmH2O and 28 cmH2O versus 23 cmH2O , respectively ; P < 0 0.05 ) . On the seventh postoperative day , in addition to inspiratory force and respiratory muscle endurance , the intervention group showed better results than controls in the functional independence measure score ( 118 versus 95 ) and 6-minute walk test distance ( 368.5 m versus 223 m ) , all P < 0 0.05 . Postoperative pulmonary complications occurred in 11 patients in the control group and five in the intervention group ( P = 0.03 ) . Conclusion : Preoperative physical therapy improved pulmonary function and physical performance in the pre- and postoperative periods among patients undergoing upper abdominal surgery BACKGROUND AND PURPOSE The purpose of this study was to determine whether the addition of incentive spirometry ( IS ) to postoperative pulmonary physical therapy is more effective than physical therapy alone in reducing postoperative pulmonary complications in high-risk patients after coronary artery bypass grafting ( CABG ) . Patients were given the spirometer and instructed in its use , as often occurs in clinical setting s. SUBJECTS Patients with chronic airflow limitation following CABG ( N = 185 ) participated . METHODS Subjects were r and omly assigned to receive either postoperative pulmonary physical therapy ( breathing exercises , secretion removal , mobility ) or physical therapy combined with IS . RESULTS No difference was found between the two groups in atelectasis , spirometry , oxygen saturation , pulmonary infection , or hospital stay . CONCLUSION AND DISCUSSION Incentive spirometry combined with physical therapy is no more effective than postoperative physical therapy alone in reducing atelectasis for this population . Use of the spirometer , however , was not monitored , and although the study mimicked practice as it often occurs , the effectiveness of the spirometer can not be fully evaluated Twenty patients undergoing an upper abdominal procedure were r and omly assigned in two groups . One group was treated with both chest physical therapy and incentive spirometry and the other was treated with chest physical therapy alone .  Spirometric values , respiratory rate , tidal volume and vital capacity were determined during the postoperative course . We observed that patients treated with incentive spirometry bad a faster return to preoperative pulmonary volumes . This observation confirms the prophylactic role of incentive spirometry in the prevention of pulmonary complications after laparotomy OBJECTIVE To examine the effect of preoperative smoking behavior on postoperative pulmonary complications . DESIGN Prospect i ve cohort study . SETTING The Veterans Administration Medical Center , Syracuse , NY . PARTICIPANTS Patients scheduled for noncardiac elective surgery ( n=410 ) . MEASUREMENTS AND RESULTS  Smoking status  was determined by self-report . Postoperative pulmonary complications were determined by systematic extraction of medical record data . Postoperative pulmonary complications occurred in 31 of 141 ( 22.0 % ) current smokers , 24 of 187 ( 12.8 % ) past smokers , and 4 of 82 ( 4.9 % ) never smokers . The odds ratio ( OR ) for developing a postoperative pulmonary complication for current smokers vs never smokers was 5.5 ( 95 % confidence interval [ CI ] , 1.9 to 16.2 ) and 4.2 ( 95 % CI , 1.2 to 14.8 ) after adjustment for type of surgery , type of anesthesia , abnormal chest radiograph , chronic cough , history of pulmonary disease , history of cardiac disease , history of COPD , education level , pulmonary function , body mass index , and age . Current smokers who reported reducing cigarette consumption  prior to surgery were more likely to develop a complication compared with those who did not ( adjusted OR=6.7 , 95 % CI , 2.6 to 17.1 ) . CONCLUSIONS Current smoking was associated with a nearly sixfold increase in risk for a postoperative pulmonary complication . Reduction in smoking within 1 month of surgery was not associated with a decreased risk of postoperative pulmonary complications Background Esophageal resection is associated with a high incidence of postoperative pneumonia . Respiratory complications account for almost half of the readmissions to the critical care unit . Postoperative complications can result in prolonged hospital stay and consequently increase healthcare costs . In cardiac surgery a preoperative inspiratory muscle training program has shown to prevent postoperative pneumonia and reduce length of hospital stay . While in some surgical centers inspiratory muscle training is already used in the preoperative phase in patients undergoing esophageal resection , the added value of this intervention on the reduction of pulmonary complications has not yet been investigated in large surgical population s other than cardiac surgery in a r and omized and controlled study design . Methods / Design The effect of a preoperative inspiratory muscle training program on the incidence of postoperative pneumonia in patients undergoing esophageal resection will be studied in a single blind multicenter r and omized controlled trial ( the PREPARE study ) . In total 248 patients ( age > 18 years ) undergoing esophageal resection for esophageal cancer will be included in this study . They are r and omized to either usual care or usual care with an additional inspiratory muscle training intervention according to a high-intensity protocol which is performed with a tapered flow resistive inspiratory loading device . Patients have to complete 30 dynamic inspiratory efforts twice daily for 7 days a week until surgery with a minimum of 2 weeks . The starting training load will be aim ed to be 60 % of maximal inspiratory pressure and will be increased based on the rate of perceived exertion . The main study endpoint is the incidence of postoperative pneumonia . Secondary objectives are to evaluate the effect of preoperative inspiratory muscle training on length of hospital stay , duration of mechanical ventilation , incidence of other postoperative ( pulmonary ) complications , quality of life , and on postoperative respiratory muscle function and lung function . Discussion The PREPARE study is the first multicenter r and omized controlled trial to evaluate the hypothesis that preoperative inspiratory muscle training leads to decreased pulmonary complications in patients undergoing esophageal resection . Trial registration NCT01893008 OBJECTIVE : Internists frequently evaluate preoperative cardiopulmonary risk and comanage cardiac and pulmonary complications , but the comparative incidence and clinical importance of these complications are not clearly delineated . This study evaluated incidence and length of stay for both cardiac and pulmonary complications after  elective laparotomy .  DESIGN : Nested case-control . SETTING : University-affiliated Department of Veterans Affairs Hospital . PATIENTS : Computerized registry of all 2,291 patients undergoing elective abdominal operations from 1982 to 1991.MEASUREMENT AND MAIN RESULTS : Strategy for ascertainment and verification of complications was systematic and explicit . The charts of all 116 patients identified by the registry as having complications and 412 ( 19 % ) r and omly selected from 2,175 remaining patients were review ed to verify presence or absence of cardiac or pulmonary complications , using explicit criteria and independent abstract ion of pre- and postoperative components of charts . From these 528 vali date d cases and controls ( 23 % of the cohort ) , 96 cases and 96 controls were matched by operation type and age within ten years . Hospital and intensive care unit stays were significantly longer ( p<0.0001 ) for the cases than for the controls ( 24.1 vs 10.3 and 5.8 vs 1.5 days , respectively ) . All 19 deaths occurred among the cases . Among the cases , pulmonary complications occurred significantly more often than cardiac complications ( p<0.00001 ) and were associated with significantly longer hospital stays ( 22.7 vs 10.4 days , p=0.001 ) . Combined cardiopulmonary complications occurred among 26 % of the cases . Misclassification-corrected incidence rates for the entire cohort were 9.6 % ( 95 % CI 7.2–12.0 ) for pulmonary and 5.7 % ( 95 % CI 3.8–7.7 ) for cardiac complications . CONCLUSIONS : For noncardiac surgery , previous research has focused on cardiac risk . In this study , pulmonary complications were more frequent , were associated with longer hospital stay , and occurred in combination with cardiac complications in a substantial proportion of cases . These results suggest that further research is needed to fully characterize the clinical epidemiology of postoperative cardiac and pulmonary complications and better guide preoperative risk assessment AIMS AND OBJECTIVES We investigated whether : ( i ) Early postoperative lateral position after coronary artery bypass surgery may have a negative influence on the cardiac output and ( ii ) Whether turning procedures cause practical problems . BACKGROUND Directly following surgery , coronary artery bypass patients are not receiving routine turning every two hours to prevent pressure ulcers , because a negative influence on hemodynamic parameters is assumed . DESIGN Clinical trial . METHODS Fifty-five coronary artery bypass patients were r and omly assigned to four intervention regimens and underwent a two-hour period of 30 degrees lateral position .  Fourteen patients in supine position  served as a reference group . We hypothesized that 30 degrees lateral position does not cause a relevant change in the cardiac output . RESULTS Turning the patients did not have any significant influence on the cardiac index , not even in the patients in a poor hemodynamic condition . The cardiac index in 30 degrees lateral position and supine position two to eight hours postoperatively after coronary artery bypass surgery is statistically bioequivalent . No clinical ly relevant deviations from preset ' safe ' values for mean arterial pressure , right atrial pressure , pulmonary artery wedge pressure and pulmonary arterial pressure were observed , which would require ending the lateral position . There were no practical problems hindering the turning regimen , not even in the patients with an intra-aortic balloon pump . CONCLUSIONS Early postoperative turning of coronary artery bypass surgery patients in lateral position is an easy and feasible procedure that does not influence the cardiac index not even in patients receiving antihypertensive or inotropic/vasopressor therapy . Further research is needed to find out whether our findings are also valid in other patient groups and other position conditions . RELEVANCE TO CLINICAL PRACTICE If there are no strict contra-indications , lateral position has to be considered to prevent complications of continuous supine position within two hours after coronary artery bypass surgery patients have been admitted to the intensive care unit PURPOSE To evaluate the routine use of pulmonary artery catheters ( PAC ) in patients who undergo aortic surgery . METHODS One hundred twenty patients were r and omized to placement of PACs for perioperative monitoring and hemodynamic optimization ( tune up ) in the intensive care unit on the night before aortic operation , or to intravenous hydration in the ward and perioperative monitoring without PACs . Before r and omization , all patients underwent routine adenosine thallium-201 scintigraphy . RESULTS To meet predetermined endpoints , 30 PAC patients ( 50 % ) received nitrates , inotropic agents , or both . PAC patients received more fluid in the preoperative period ( p < 0.001 ) and in the first 24 hours after operation ( p = 0.002 ) than control subjects . Eleven PAC patients ( 18 % ) and three control subjects ( 5 % ) had adverse intraoperative events ( p = 0.02 ) . There were 20 adverse postoperative events in 15 PAC patients ( 25 % ; nine cardiac , seven pulmonary , four acute tubular necrosis ) , which was not different compared with 11 postoperative events in 10 control subjects ( 17 % ; five cardiac , five pulmonary , one acute tubular necrosis ) . There were also no differences in duration of mechanical ventilation , intensive care unit stay , or hospital stay between groups . Postoperative cardiac complications were more common among patients who had a history of congestive heart failure ( p = 0.02 ; odds ratio , 3.75 ; confidence interval , 1.3 to 11 ) or reperfusion defects on adenosine thallium scintigraphy ( p = 0.01 ; odds ratio , 3.4 ; confidence interval , 1.2 to 9.4 ) , regardless of group . CONCLUSIONS Routine use of PACs for perioperative monitoring with the above protocol during aortic surgery is not beneficial and may be associated with a higher rate of intraoperative complications . Preoperative tune up does not prevent postoperative cardiac , renal , and other complications . Variables such as cardiac risk factors and adenosine thallium scintigraphy may be more important predictors of cardiac events in patients who undergo aortic operations OBJECTIVE To evaluate the occurrence and risk of pulmonary complications in children who underwent pre- and postoperative physiotherapeutic intervention in cardiac surgeries , as well as to compare these patients to those who underwent only postoperative physiotherapeutic intervention . METHODS A r and omized controlled trial was performed with 135 patients from 6 years of age and younger with congenital heart disease who had undergone cardiac surgery . Patients were r and omly assigned to the intervention group ( G1 ) in which they underwent pre- and postoperative physiotherapy or to the control group ( G2 ) in which they underwent only postoperative physiotherapy . Mann-Whitney and the Chi-square tests were used to compare the variables between the groups . The magnitude of the absolute risk was calculated by the number of patients needed to treat . Statistical significance was set at 5 % ( P<0.05 ) . RESULTS 17 patients ( 25 % ) in G1 , and 29 patients ( 43.3 % ) in G2 presented pulmonary complications ( P= 0.025 ) , pneumonia was the most frequent complication , and among the 17 patients in G1 , seven ( 10.3 % ) developed pneumonia , six ( 8.8 % ) developed atelectasis , and four ( 5.9 % ) presented complications due to both complications . In G2 , 13 patients ( 19.4 % ) developed pneumonia , eight ( 11.9 % ) developed atelectasis , and eight ( 11.9 % ) developed pneumonia associated with atelectasis . Absolute risk reduction for the primary outcome was of 18.3 % and the number of needed to treat was 5.5 . CONCLUSION Preoperative respiratory physiotherapy significantly reduced the risk of pulmonary complications in postoperative pediatric cardiac surgery This study compared the effects of preoperative physical therapy or general cardiovascular conditioning exercises with the routine procedure of no preoperative physical therapy on patients undergoing primary total knee replacement . Thirty patients were r and omly assigned to 1 of 3 groups . Group 1 was the control group . Group 2 participated in a physical therapy program design ed to strengthen the upper and lower limbs and improve knee range of motion . Group 3 participated in a cardiovascular conditioning program , consisting of arm ergometry , cycle ergometry , aquatic exercises , and aerobic activity . All patients were evaluated preoperatively and postoperatively using the Hospital for Special Surgery Knee Rating , the Arthritis Impact Measurement Scale , and the Quality of Well Being instrument . Both experimental groups tolerated their respective exercise protocol s extremely well . All 3 groups showed significant improvement postoperatively as measured by the Hospital for Special Surgery Knee Rating , the Arthritis Impact Measurement Scale and the Quality of Well Being measurement scales . However , neither type of preoperative exercise added to the degree of improvement after surgery at any of the postoperative evaluations PURPOSE To determine the relation between cardiac and noncardiac complications and their effects on length of stay in patients undergoing noncardiac surgery . METHODS We collected detailed information from the history , physical examination , and preoperative tests of 3970 patients aged > or = 50 years who were undergoing major noncardiac procedures . Serial electrocardiograms and cardiac enzyme measurements were performed perioperatively , and cardiac and noncardiac complications were recorded prospect ively . Multivariate logistic regression analysis was used to determine the association between cardiac and noncardiac complications , and linear regression was used to assess their effects on length of stay . RESULTS Cardiac complications occurred in 84 patients ( 2 % ) , and noncardiac complications developed in 510 patients ( 13 % ) . Both types of complications occurred in 40 patients ( 1 % ) . The most common cardiac complications were pulmonary edema ( n = 42 ) and myocardial infa rct ion ( n = 41 ) . The most common noncardiac complications were wound infection ( n = 291 ) , confusion ( n = 87 ) , respiratory failure requiring intubation ( n = 62 ) , deep venous thrombosis ( n = 48 ) , and bacterial pneumonia ( n = 46 ) . Patients with cardiac complications were more likely to suffer a noncardiac complication than were those without cardiac complications , even after adjustment for preoperative clinical factors ( odds ratio = 6.4 ; 95 % confidence interval [ CI ] : 3.9 to 10.6 ) . Mean length of stay was markedly increased in patients who experienced cardiac ( 11 days ; 95 % CI : 9 to 12 days ) or noncardiac ( 11 days ; 95 % CI : 10 to 12 days ) complications , or both ( 15 days ; 95 % CI : 12 to 18 days ) , as compared with patients without complications ( 4 days ; 95 % CI : 3 to 4 days ) , even after adjustment for procedure type and clinical factors . CONCLUSION Cardiac and noncardiac complications were strongly linked in patients undergoing noncardiac surgery . Patients who experienced one type of complication were at increased risk of developing the other type of complication as well as prolonged perioperative length of stay Abstract . Background : The efficacy of nasal continuous positive airway pressure ( nCPAP ) as a prophylactic method for preventing cardiopulmonary complications after major vascular surgery has not been investigated . Patients / methods : In a prospect i ve r and omized trial , 204 patients undergoing elective midline laparotomy for vascular surgery were r and omized to receive st and ard therapy ( n=105 ) or additional prophylactic nCPAP ( n=99 ) for the first postoperative night . Postoperative oxygenation , incidence of severe cardiac , and pulmonary complications , length of intensive care surveillance and length of total postoperative hospital stay ( LOS ) were compared . Results : Prophylactic nCPAP significantly reduced the number of patients with severe oxygenation disturbances defined as paO2<70 mmHg with FiO2≥ 0.7 ( 5 versus 17 , P=.01 ) . There were no differences with respect to death , cardiac and pulmonary complications , length of intensive care surveillance or LOS . Conclusion : Prophylactic 12 h nCPAP significantly reduces the occurrence of postoperative oxygenation disturbances but has no effect on cardiac or pulmonary complications , need for intensive care , LOS or mortality after major vascular surgery One hundred twenty patients undergoing coronary artery surgery completed a r and omized controlled study design ed to investigate whether prophylactic chest physiotherapy affected the incidence of postoperative pulmonary complications . Group 1 patients received no preoperative or postoperative chest physiotherapy . Group 2 patients received preoperative education and instruction in breathing and coughing exercises and postoperative supervision and assistance in performing the same . These exercises were supervised by a physiotherapist twice per day on the first 2 postoperative days and once per day on the 3rd and 4th postoperative days . Physiotherapy for group 3 patients was the same as for group 2 patients except that patients were seen by a physiotherapist 4 times per day on the first 2 postoperative days and twice per day on the 3rd and 4th postoperative days . Group 2 and 3 patients were instructed to practice breathing and coughing exercises every hour . Overall , an incidence of clinical ly significant postoperative pulmonary complications of 7.5 percent was demonstrated . In general , these patients demonstrated lower levels of preoperative pulmonary function and very low early postoperative oxygenation compared with those who did not develop pulmonary complications . There was no indication that the incidence or severity of fever , hypoxemia , chest roentgenologic abnormalities or clinical ly significant postoperative pulmonary complications was different between groups . These results suggest that the necessity for prophylactic chest physiotherapy after routine coronary artery surgery should be review ed Forty-nine adults who had undergone cardiopulmonary bypass surgery were r and omly assigned to one of three exercise programs to determine if either maximal inspiratory breathing exercises or incentive spirometry offered a therapeutic advantage over early mobilization alone . After extubation , the patients started their assigned exercise programs . A physical examination and pulmonary function tests were performed preoperatively , at the start of the exercise program , and 24 and 48 hours after the start of the program . The results showed a significant decrease ( approximately 50 % ) in lung volumes but no airflow obstruction in patients who had coronary artery bypass graft . In those patients who had valve replacement , lung volumes fell , and in addition , mild airflow obstruction occurred . A majority of patients had postoperative pulmonary complications . There were no significant differences among the exercise programs in improving lung volumes and airflow or in preventing postoperative complications . We conclude that maximal inspiratory breathing exercises or incentive spirometry , when used in addition to early mobilization , offers no therapeutic advantage over early mobilization alone after cardiopulmonary bypass surgery CONTEXT Postoperative pulmonary complications ( PPCs ) after coronary artery bypass graft ( CABG ) surgery are a major source of morbidity and mortality , and increase length of hospital stay and re source utilization . The prehospitalization period before CABG surgery may be used to improve a patient 's pulmonary condition . The efficacy of preoperative inspiratory muscle training ( IMT ) in reducing the incidence of PPCs in high-risk patients undergoing CABG surgery has not yet been determined . OBJECTIVE To evaluate the prophylactic efficacy of preoperative IMT on the incidence of PPCs in high-risk patients scheduled for elective CABG surgery . DESIGN , SETTING , AND PATIENTS A single-blind , r and omized clinical trial conducted at the University Medical Center Utrecht , Utrecht , the Netherl and s , with enrollment between July 2002 and August 2005 . Of 655 patients referred for elective CABG surgery , 299 ( 45.6 % ) met criteria for high risk of developing PPCs , of whom 279 were enrolled and followed up until discharge from hospital . INTERVENTION Patients were r and omly assigned to receive either preoperative IMT ( n = 140 ) or usual care ( n = 139 ) . Both groups received the same postoperative physical therapy . MAIN OUTCOME MEASURES Incidence of PPCs , especially pneumonia , and duration of postoperative hospitalization . RESULTS Both groups were comparable at baseline . After CABG surgery , PPCs were present in 25 ( 18.0 % ) of 139 patients in the IMT group and 48 ( 35.0 % ) of 137 patients in the usual care group ( odds ratio [ OR ] , 0.52 ; 95 % confidence interval [ CI ] , 0.30 - 0.92 ) . Pneumonia occurred in 9 ( 6.5 % ) of 139 patients in the IMT group and in 22 ( 16.1 % ) of 137 patients in the usual care group ( OR , 0.40 ; 95 % CI , 0.19 - 0.84 ) . Median duration of postoperative hospitalization was 7 days ( range , 5 - 41 days ) in the IMT group vs 8 days ( range , 6 - 70 days ) in the usual care group by Mann-Whitney U statistic ( z = -2.42 ; P = .02 ) . CONCLUSION Preoperative IMT reduced the incidence of PPCs and duration of postoperative hospitalization in patients at high risk of developing a pulmonary complication undergoing CABG surgery . TRIAL REGISTRATION is rct n.org Identifier : IS RCT N17691887 A prospect i ve study of 500 consecutive patients surviving the first 24 hours following cardiac surgical procedures  was undertaken to determine the prevalence , etiology and results of therapy for  postoperative acute renal failure ( ARF ) . Thirty-five patients developed either moderate or severe ARF and an additional 102 developed mild preprenal azotemia . Positive risk factors noted inthe development of postoperative renal failure included age , elevated preoperative concentrations of blood urea nitrogen ( BUN ) , serum creatinine , and decreased 24 hour urine creatinine clearance . The duration of cardiopulmonary bypass ( CPB ) , aortic cross-clamping , and the total duration of the operation also closely correlated with the incidence of ARF . In the early postoperative period , clinical assessment of hemodynamic change was most helpful in predicting postoperative ARF . Significant negative risk factors included type of operation performed , New York Heart Association classification , the use of preoperative diuretic therapy , and associated other chronic illnesses . During the operation itself , the lowest and mean blood pressures , flow rates on CPB and the presence of hemoglobinuria failed to correlate with subsequent ARF . The mortality rate for established ARF was extremely poor ( 88.8 per cent ) , and there were no survivors among those requiring dialysis . ARF following cardiac surgery is a highly lethal complication which arises in a setting of inadequate cardiac function and is associated with a multiple organ system failure . Therapy of this postoperative complication , therefore , appears to be better directed toward its prevention rather than treatment once established Background Even several days after surgery , obese patients exhibit a measureable amount of atelectasis and thus are predisposed to postoperative pulmonary complications . Particularly in ambulatory surgery , rapid recovery of pulmonary function is desired to ensure early discharge of the obese patient . In this study , we wanted to evaluate intensive short-term respiratory physical therapy treatment ( incentive spirometry ) in the postanesthesia care unit ( PACU ) and its impact on pulmonary function in the obese . Methods After ethics committee approval and informed consent , we prospect ively studied 60 obese patients ( BMI 30–40 ) undergoing minor peripheral surgery  , half of which were r and omly assigned to receive  respiratory physiotherapy  during their PACU stay , while the others received routine treatment . Premedication , general anesthesia , and respiratory setting s were st and ardized . We measured arterial oxygen saturation by pulse oximetry on air breathing . Inspiratory and expiratory lung functions were measured preoperatively ( baseline ) and at 10 min , 1 , 2 , 6 , and 24 h after extubation , with the patient supine , in a 30 ° head-up position . The two groups were compared using repeated-measure analysis of variance and t test analysis . Statistical significance was considered to be P < 0.05 . Results There were no differences at the first assessment , but , during the PACU stay , pulmonary function in the physiotherapy group was significantly better than the controls ’ ( p < 0.0001 ) , an effect which persisted for at least 24 h after surgery ( p < 0.009 ) . ConclusionS hort-term respiratory physiotherapy during the PACU stay promotes more rapid recovery of postoperative lung function in the obese during the first 24 Objectives : To investigate the effects of a preoperative pulmonary rehabilitation programme in patients with lung cancer undergoing video-assisted thoracic surgery .  Design : R and omized , single-blind controlled trial . Setting : Teaching hospital . Subjects : Patients with suspected or confirmed lung cancer undergoing video-assisted thoracic surgery .  Intervention : Participants were r and omized  to either a prehabilitation group or a control group .  Participants in the prehabilitation group underwent a combination of moderate endurance and resistance training plus breathing exercises three to five times per week . Main measures : The primary outcome of the study was exercise capacity . Secondary outcomes were muscle strength ( Senior Fitness Test ) , health-related quality of life ( Short-Form 36 ) and the postoperative outcomes . Patients were evaluated at baseline ( before r and omization ) , presurgery ( only the prehabilitation group ) , after surgery and three months post-operatively . Results : A total of 40 patients were r and omized and 22 finished the study ( 10 in the prehabilitation group and 12 in the control group ) . Three patients were lost to follow-up at three months . After the training , there was a statistically significant improvement in exercise tolerance ( + 397 seconds , p = 0.0001 ) , the physical summary component of the SF-36 ( + 4.4 points , p = 0.008 ) and muscle strength ( p < 0.01 ) . There were no significant differences between groups after surgery . However , three months postoperatively , significant differences were found in the mean change of exercise capacity ( p = 0.005 ) , physical summary component ( p = 0.001 ) and upper and lower body strength ( p = 0.045 and p = 0.002 ) . Conclusions : A pulmonary rehabilitation programme before video-assisted thoracic surgery seems to improve patients ’ preoperative condition and may prevent functional decline after surgery . Clinical Registration Number : NCT01963923 ( Registration date 10/10/2013 Background : Most reports on postoperative ( OP ) morbidity and mortality following breast cancer surgery ( BCS ) are limited by relatively small sample size result ing in a lack of national benchmarks for quality of care . This paper reports the 30-day morbidity and mortality following BCS in women using a large prospect i ve multi-institutional data base . Methods : The National Surgical Quality Improvement Program Patient Safety in Surgery , prospect ively collected inpatient and outpatient 30 day postoperative morbidity and mortality data on patients undergoing surgery at 14 university and 4 community centers . Using the procedure CPT code , the data base was queried for all women undergoing mastectomy ( MT ) or lumpectomy with an axillary procedure ( L-ANP ) .  Morbidity and mortality were categorized as mortality , wound , cardiac , renal , pulmonary , and central nervous system . Logistic regression models for the prediction of wound complications were developed . Preoperative variables having bivariate relationships with postoperative wound complications with P ≤ 0.20 were su bmi tted for consideration . Results : We identified 1660 and 1447 women who underwent MT and l-ANP , respectively . The mean age was 55.9 years . The majority of procedures were under general anesthesia . The 30-day postoperative mortality for MT and l-ALNP were 0.24 % and 0 % , respectively . The most frequent morbid complication was wound infection , more commonly occurring in the mastectomy ( 4.34 % ) group versus the lumpectomy group ( 1.97 % ) . Cardiac and pulmonary complications occurred infrequently in the mastectomy group ( cardiac : MT , 0.12 % ; and pulmonary : MT , 0.66 % ) . There were no cardiac or pulmonary complications in the lumpectomy group . CNS morbidities were rare in both surgical groups ( MT , 0.12 % ; and l-ALNP , 0.07 % ) . Development of a UTI was more common in women who underwent a mastectomy ( 0.66 % ) when compared with women that had a lumpectomy ( 0.14 % ) . The only significant predictors of a wound complication were morbid obesity ( BMI > 30 ) , having had a MT , low preoperative albumin and hematocrit greater than 45 % . Conclusion : Morbidity and mortality rates following BCS in women are low , limiting their value in assessing quality of care . Mastectomy carries higher complication rate than l-ANP with wound infection being the most common The aim of this study was to establish whether removal of breathing exercises from a regimen including early mobilisation changes the incidence of post-operative pulmonary complications for patients after cardiac surgery . Two hundred and thirty patients undergoing open heart surgery at Monash Medical Centre , Melbourne , were enrolled in this r and omised controlled trial . All patients received physiotherapy treatment pre-operatively and post-operatively for three days . Patients were mobilised as soon as possible after surgery . Breathing group ( control ) patients performed a set routine of deep breathing exercises at each physiotherapy visit while those in the intervention group did not perform this routine . Other than the breathing exercises , patient management was similar between groups in terms of assessment , positioning and mobility . The incidence of postoperative pulmonary complications , post-operative length of stay , oxyhaemoglobin saturation and pulmonary function were measured pre-operatively and post-operatively . Intention-to-treat analysis was performed for post-operative pulmonary complications and length of stay . Other data were analysed using t-tests , chi square and repeated measures analysis of variance . There were no significant differences between the groups in the primary dependent variables . It is concluded that removal of breathing exercises from the routine physiotherapy management of open heart surgery patients does not significantly alter patient outcome
Evidence derived from small trials suggests that preoperative physical therapy reduces postoperative pulmonary complications ( atelectasis and pneumonia ) and length of hospital stay in patients undergoing elective cardiac surgery .
There is a lack of evidence that preoperative physical therapy reduces postoperative pneumothorax , prolonged mechanical ventilation or all-cause deaths
BACKGROUND After cardiac surgery , physical therapy is a routine procedure delivered with the aim of preventing postoperative pulmonary complications .
OBJECTIVES To determine if preoperative physical therapy with an exercise component can prevent postoperative pulmonary complications in cardiac surgery patients , and to evaluate which type of patient benefits and which type of physical therapy is most effective .