Training for recovery before major surgery

Imagine you are about to undergo a major abdominal operation. In the lead up to your surgery you meet a number of medical experts including anaesthetists, surgeons and specialist nurses.

But then you’re paid a visit by a health professional many might expect to see on the sports field, not in a hospital: a physiotherapist.

But our new research, conducted with 441 patients and published in The British Medical Journal, shows that pre-operative visits from physiotherapists halve the rate of serious, potentially deadly, respiratory complications for patients having major abdominal surgery.

Abdominal surgery is required for treatment of various cancers and other conditions of the bowel, stomach, liver, kidney and other organs. Unfortunately this type of surgery carries a risk of serious respiratory complications, like pneumonia and lung collapse.

The cut the surgeon makes in the abdomen causes the breathing muscles to become weak and less able to do their job, so much so that breathing after surgery can be quite shallow, and this can cause the lungs to collapse.

Additionally, the anaesthetic drugs can cause the lungs to reduce how well they clean themselves of the bacteria carried in the air we breath. This means bacteria can stagnate in the lungs in the days following surgery, increasing the risk of pneumonia.

Respiratory complications after surgery can lead to high mortality and healthcare costs. Because of this, almost all hospitals, both public and private, around Australia have physiotherapists on hospital wards to see patients after their operation to teach and coach them to do breathing and coughing exercises to reverse the lung problems caused by surgery.

Frustratingly though, many chest infections occur quite early after the operation and physiotherapists may be seeing the patient too late.

Previous inconclusive trials suggested that a physiotherapist teaching patients breathing exercises before undergoing major surgery like this might prevent up to 80 per cent of these respiratory complications.

But the possible effectiveness of physiotherapist involvement needed to be confirmed in a definitive study.

Our team of University of Melbourne researchers collaborated with physiotherapists in three hospitals in Australia and New Zealand to measure the effect of teaching abdominal surgery patients about their surgery and simple techniques, like deep breathing and coughing, to manage the risk of post-operative respiratory complications.

It turns out this simple, low-cost, risk-free intervention is highly effective.

In our study, all patients received information about post-operative chest infections in a booklet. Half of these patients also received an additional 30-minute, face-to-face physiotherapy education and breathing exercise training session.

These patients were taught about their risk of post-operative chest infection and shown simple breathing exercises which they were urged to start as soon as they woke up from surgery. They were encouraged to continue performing them 20 times hourly until they were getting up and out of bed frequently and walking around.

After taking into account the patients’ ages and other health disorders, the results showed those who received the pre-operative physiotherapy visit had half the chest infection rate of those who only received the booklet.

For every seven patients given breathing training by a physiotherapist before surgery, one chest infection was avoided.

The treatment worked best in male patients, those having bowel or colorectal surgery, and in patients who were younger than 65.

And in cases where a more experienced physiotherapist treated patients, there was also a reduction in hospital length of stay and a 70 per cent drop in mortality at 12 months.

The key to bringing down rates of respiratory complications is the physiotherapist seeing the patient before surgery, not just afterwards.

Major surgery is like running a marathon - you have to train for it. And part of that training is preparing for recovery.

Explaining to patients prior to surgery what happens to the lungs during the operation and, vitally, how these problems can be reversed with simple deep breathing and coughing exercises they can do themselves as soon as they wake up, are simple measures, but their impact can be enormous.

The next step is to calculate exact hospital costs saved by this intervention, and to test these pre-operative physiotherapy sessions on other surgeries such as open heart surgery, lung surgery, and brain surgery.

With the potential to saves lives and health dollars, this low-cost, low fuss, once-off physiotherapy treatment could be easily rolled out nationwide.

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