Clinical-demographic characteristics of subjects from the general surgery ward who required consultation with the physical therapy unit of a public hospital in the Autonomous City of Buenos Aires: a descriptive and retrospective study
Abstract
Objective: To describe the clinical-demographic characteristics of subjects who were hospitalized after a surgical intervention and received physical therapy (PT) in the general surgery ward of a public hospital in the Autonomous City of Buenos Aires (CABA). The secondary objective is to describe the use of oxygen therapy devices, the development of postoperative pulmonary complications (PPC), and the time elapsed until PT.
Materials y methods: We included data from the PT records of subjects who underwent abdominal, thoracic, or pelvic surgical interventions and received PT between January 2019 and December 2022. Demographic and clinical data, reason for PT consultation, development of PPC, number of days of PT, and use of oxygen therapy devices were recorded.
Results: A total of 151 records were included. Of the total, 15 subjects (9.9 %) developed PPC. In this group, the median number of days elapsed between the surgical intervention and the onset of PT was 8 days (IQR 4-16), while for subjects who did not develop complications, it was 4 days (IQR 2-7). A total of 57 subjects (37.5 %) needed oxygen therapy, with 3 subjects requiring invasive mechanical ventilation and 1 requiring non-invasive mechanical ventilation.
Conclusion: We described the clinical-demographic characteristics of postoperative subjects hospitalized in the general surgery ward of a general acute hospital in the CABA. Subjects with PPC received PT over an extended period and required supplemental oxygen for a longer period. Subjects who did not develop PPC received PT earlier, compared with those who developed complications.
References
Weiser TG, Haynes AB, Molina G, Lipsitz SR, Esquivel MM, Uribe-Leitz T, et al. Size and distribution of the global volume of surgery in 2012. Bull World Health Organ. 2016;94(3):201-209F. doi: 10.2471/BLT.15.159293
Crossref
| Google Scholar
Abbott TEF, Fowler AJ, Dobbs TD, Harrison EM, Gillies MA, Pearse RM. Frequency of surgical treatment and related hospital procedures in the UK: a national ecological study using hospital episode statistics. Br J Anaesth. 2017;119(2):249-257. doi: 10.1093/bja/aex137
Crossref
| Google Scholar
Fernandez-Bustamante A, Frendl G, Sprung J, Kor DJ, Subramaniam B, Martinez Ruiz R, et al. Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery: A Multicenter Study by the Perioperative Research Network Investigators. JAMA Surg. 2017;152(2):157-166. doi: 10.1001/jamasurg.2016.4065
Crossref
| Google Scholar
Smetana GW. Postoperative pulmonary complications: an update on risk assessment and reduction. Cleve Clin J Med. 2009;76 Suppl 4:S60-5. doi: 10.3949/ccjm.76.s4.10
Crossref
| Google Scholar
Miskovic A, Lumb AB. Postoperative pulmonary complications. Br J Anaesth. 2017;118(3):317-334. doi: 10.1093/bja/aex002
Crossref
| Google Scholar
Abbott TEF, Fowler AJ, Pelosi P, Gama de Abreu M, Møller AM, Canet J, et al. A systematic review and consensus definitions for standardised end-points in perioperative medicine: pulmonary complications. Br J Anaesth. 2018;120(5):1066-1079. doi: 10.1016/j.bja.2018.02.007
Crossref
| Google Scholar
Sasaki N, Meyer MJ, Eikermann M. Postoperative respiratory muscle dysfunction: pathophysiology and preventive strategies. Anesthesiology. 2013;118(4):961-78. doi: 10.1097/ALN.0b013e318288834f
Crossref
| Google Scholar
Boden I, Skinner EH, Browning L, Reeve J, Anderson L, Hill C, et al. Preoperative physiotherapy for the prevention of respiratory complications after upper abdominal surgery: Pragmatic, double blinded, multicentre randomized controlled trial. The BMJ. 2018;360. doi: 10.1136/bmj.j5916
Crossref
| Google Scholar
Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N, McNaught CE, Macfie J, Liberman AS, Soop M, Hill A, Kennedy RH, Lobo DN, Fearon K, Ljungqvist O; Enhanced Recovery After Surgery (ERAS) Society, for Perioperative Care; European Society for Clinical Nutrition and Metabolism (ESPEN); International Association for Surgical Metabolism and Nutrition (IASMEN). Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS(®)) Society recommendations. World J Surg. 2013;37(2):259-84. doi: 10.1007/s00268-012-1772-0
Crossref
| Google Scholar
Hanekom SD, Brooks D, Denehy L, Fagevik-Olsén M, Hardcastle TC, Manie S, Louw Q. Reaching consensus on the physiotherapeutic management of patients following upper abdominal surgery: a pragmatic approach to interpret equivocal evidence. BMC Med Inform Decis Mak. 2012;12:5. doi: 10.1186/1472-6947-12-5
Crossref
| Google Scholar
Marley RA. Postoperative oxygen therapy. J Perianesth Nurs. 1998;13(6):394-410; quiz 410-2. doi: 10.1016/S1089-9472(98)80010-5
Crossref
| Google Scholar
Liu K, Scott JB, Jing G, Li J. Management of Postoperative Hypoxemia. Respir Care. 2021;66(7):1136-1149. doi: 10.4187/respcare.08929
Crossref
| Google Scholar
Souza Possa S, Braga Amador C, Meira Costa A, Takahama Sakamoto E, Seiko Kondo C, Maida Vasconcellos AL, et al. Implementation of a guideline for physical therapy in the postoperative period of upper abdominal surgery reduces the incidence of atelectasis and length of hospital stay. Rev Port Pneumol. 2014;20(2):69-77. doi: 10.1016/j.rppneu.2013.07.005
Crossref
| Google Scholar
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83. doi: 10.1016/0021-9681(87)90171-8
Crossref
| Google Scholar
O'Donohue WJ Jr. Postoperative pulmonary complications. When are preventive and therapeutic measures necessary? Postgrad Med. 1992;91(3):167-70, 173-5. doi: 10.1080/00325481.1992.11701233
Crossref
| Google Scholar
Jeong BH, Shin B, Eom JS, Yoo H, Song W, Han S, et al. Development of a prediction rule for estimating postoperative pulmonary complications. PLoS One. 2014;9(12):e113656. doi: 10.1371/journal.pone.0113656
Crossref
| Google Scholar
McAlister FA, Bertsch K, Man J, Bradley J, Jacka M. Incidence of and risk factors for pulmonary complications after nonthoracic surgery. Am J Respir Crit Care Med. 2005;171(5):514-7. doi: 10.1164/rccm.200408-1069OC
Crossref
| Google Scholar
Scholes RL, Browning L, Sztendur EM, Denehy L. Duration of anaesthesia, type of surgery, respiratory co-morbidity, predicted VO2max and smoking predict postoperative pulmonary complications after upper abdominal surgery: an observational study. Aust J Physiother. 2009;55(3):191-8. doi: 10.1016/S0004-9514(09)70081-9
Crossref
| Google Scholar
Mazo V, Sabaté S, Canet J, Gallart L, de Abreu MG, Belda J, et al.. Prospective external validation of a predictive score for postoperative pulmonary complications. Anesthesiology. 2014;121(2):219-31. doi: 10.1097/ALN.0000000000000334
Crossref
| Google Scholar
Han B, Li Q, Chen X. Frailty and postoperative complications in older Chinese adults undergoing major thoracic and abdominal surgery. Clin Interv Aging. 2019;14:947-957. doi: 10.2147/CIA.S201062
Crossref
| Google Scholar
Bendixen HH, Hendley-Whiete J, Laver MB. Impaired oxigenation in surgical patients during general anesthesia with controlled ventilation. A concept of atelectasis. N Engl J Med. 1963;269:991-6. doi: 10.1056/NEJM196311072691901
Crossref
| Google Scholar
Brismar B, Hedenstierna G, Lundquist H, Strandberg A, Svensson L, Tokics L. Pulmonary densities during anesthesia with muscular relaxation--a proposal of atelectasis. Anesthesiology. 1985;62(4):422-8. doi: 10.1097/00000542-198504000-00009
Crossref
| Google Scholar
Lundquist H, Hedenstierna G, Strandberg A, Tokics L, Brismar B. CT-assessment of dependent lung densities in man during general anaesthesia. Acta Radiol. 1995;36(6):626-32. doi: 10.3109/02841859509176761
Crossref
| Google Scholar
Arozullah AM, Khuri SF, Henderson WG, Daley J; Participants in the National Veterans Affairs Surgical Quality Improvement Program. Development and validation of a multifactorial risk index for predicting postoperative pneumonia after major noncardiac surgery. Ann Intern Med. 2001;135(10):847-57. doi: 10.7326/0003-4819-135-10-200111200-00005
Crossref
| Google Scholar
Gupta H, Gupta PK, Schuller D, Fang X, Miller WJ, Modrykamien A, Wichman TO, Morrow LE. Development and validation of a risk calculator for predicting postoperative pneumonia. Mayo Clin Proc. 2013;88(11):1241-9. doi: 10.1016/j.mayocp.2013.06.027
Crossref
| Google Scholar
Li C, Yang WH, Zhou J, Wu Y, Li YS, Wen SH, et al. Risk factors for predicting postoperative complications after open infrarenal abdominal aortic aneurysm repair: results from a single vascular center in China. J Clin Anesth. 2013;25(5):371-378. doi: 10.1016/j.jclinane.2013.01.013
Crossref
| Google Scholar
Kaneda H, Saito Y, Okamoto M, Maniwa T, Minami K, Imamura H. Early postoperative mobilization with walking at 4 hours after lobectomy in lung cancer patients. Gen Thorac Cardiovasc Surg. 2007;55(12):493-8. doi: 10.1007/s11748-007-0169-8
Crossref
| Google Scholar
Svensson-Raskh A, Schandl AR, Ståhle A, Nygren-Bonnier M, Fagevik Olsén M. Mobilization Started Within 2 Hours After Abdominal Surgery Improves Peripheral and Arterial Oxygenation: A Single-Center Randomized Controlled Trial. Phys Ther. 2021;101(5):pzab094. doi: 10.1093/ptj/pzab094
Crossref
| Google Scholar
Haines KJ, Skinner EH, Berney S, Austin Health PSI. Association of postoperative pulmonary complications with delayed mobilization following major abdominal surgery: an observational cohort study. Physiotherapy. 2013;99(2):119–25. doi: 10.1016/j.physio.2012.05.013
Crossref
| Google Scholar
Hanada M, Kanetaka K, Hidaka S, Taniguchi K, Oikawa M, Sato S, et al. Effect of early mobilization on postoperative pulmonary complications in patients undergoing video-assisted thoracoscopic surgery on the esophagus. Esophagus. 2018;15(2):69-74. doi: 10.1007/s10388-017-0600-x
Crossref
| Google Scholar
