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Abstract
Introduction: Developments in the areas of anaesthesia, analgesia, and pre- and postoperative care have decreased the risk of postoperative pulmonary complications (PPCs) after abdominal and thoracic surgery. Preoperative educational and training interventions to optimize patient status may further reduce these risks.
Objectives: To evaluate the level of evidence for educational and training interventions before abdominal and thoracic surgery.
Methods: A literature search for clinical studies evaluating effects of different educational and training interventions in adults before major, open abdominal or thoracic surgery was done in the following databases: MEDLINE/PubMed, CINAHL, PEDro, and Cochrane. Reference lists of articles that were identified were searched for additional relevant studies. All searches were limited to full-length articles written in English. Published trials evaluating preoperative treatment postoperatively were included. The randomized controlled trials were evaluated concerning their internal validity and the degree of evidence for different interventions was set.
Results: Nineteen articles were included. The results indicated that there were: no evidence that preoperative information or general or deep breathing exercises before admission were effective in preventing PPC, a low degree of evidence that preoperative pulmonary rehabilitation was effective in preventing PPC, increasing peak expiratory flow, and shortening ventilation time and the hospital stay, a moderate degree of evidence that inspiratory muscle training (IMT) increased muscle endurance, and a low degree of evidence that IMT decreased PPC and shortened hospital stay.
Conclusion: There is currently evidence that pulmonary rehabilitation and breathing exercises including IMT are effective in preventing PPC and should therefore be considered in clinical practice.