To determine the incidence of PPCs and explore impacts on clinical outcomes. To audit physiotherapy interventions and relationship to PPC risk.
CHESTY was an international prospective observational cohort study of 5000 patients from 35 hospitals across five countries; Australia, New Zealand, Sweden, Canada, and Malaysia.
Patients having major emergency or elective abdominal, cardiac, thoracic, vascular, neuro, spinal, transplants, or head and neck surgery were screened daily using the Melbourne Group PPC Scale standardized criteria over the first seven postoperative days. Length of stay, ICU readmissions, reintubation rates, in-hospital mortality, and discharge destination were recorded. All perioperative physiotherapy interventions delivered were recorded
PPC incidence is reported with 95% confidence intervals. Associations between PPC and clinical outcomes and relationships between physiotherapy interventions and PPC onset were explored using adjusted multivariate regression analyses.
Across 5000 surgical patients the overall PPC incidence was 18% (17% to 20%). Incidence was significantly higher following emergency/expedited procedures (emergency 28% (24% to 29%) versus elective 14% (13% to 15%), p0.001).
Following elective procedures, PPC incidence was highest after major cardiac (n=644; 33% (30% to 37%)) and vascular surgery (n=65, 23% (15% to 35%). PPCs incidences after thoracic surgery (n=330, 16% (12% to 20%), transplants (n=55, 15% (8% to 26%)), and head and neck surgery (n=180, 12% (8% to 17%)) were relatively similar
PPC incidence was significantly higher after upper abdominal surgery (n=1453; 10% (8% to 11%) compared to lower abdominal surgery (n=380; 4% (3% to 7%); p0.001). PPC rates after neurosurgery (n=110) and spinal surgery (n=125) were low at 6.4% and 1.6% respectfully.
PPCs were strongly associated with unplanned reintubations (RR 4.1 (95%CI 2.7 to 6.2), ICU readmissions (RR 3.1 (95%CI 2.3 to 4.1), in-hospital mortality (RR 3.2 (95%CI 1.7 to 6.3), acute hospital stay (MD 6.7 days (95%CI 5.6 to 7.9 days), and sub-acute rehabilitation requirements (RR 2.2 (95%CI 1.5 to 3.3).
On adjusting for surgery type, urgency, age, and comorbidities, the delivery of preoperative education and breathing exercise training was independently associated with a large 50% reduction in the risk of developing a PPC (RR 0.51, 95% CI 0.41 to 0.65, p=0.001). Assisted ambulation on the first postoperative day was associated with a 28% reduction of PPC risk (RR 0.72, 95% CI 0.61 to 0.85).
Postoperative pulmonary complications are common and strongly associated with poor outcomes. Perioperative physiotherapy interventions are strongly associated with a reduction in PPC risk. Research is needed to investigate treatments to lower PPC incidence in emergency, cardiac, and vascular surgery populations.
PPC incidence after major elective cardiac and vascular surgery are higher than historically reported values. Physiotherapists should implement evidence-based therapies already proven to reduce the risk of a PPC.
Perioperative physiotherapy
Pneumonia
