Prevention of postoperative pulmonary complications through respiratory rehabilitation: A controlled clinical study

Objective: To investigate the efficacy of respiratory rehabilitation in preventing postoperative pulmonary complications (PPC) and to define which patients can benefit. Design: A randomized clinical trial. Setting: A public hospital. Patients: Eighty-one patients who had upper abdominal surgery were distributed into two homogeneous groups: control (n = 41) and rehabilitation (n = 40). Intervention: Breathing exercises in the rehabilitation group. Main Outcome Measures: Preoperative and postoperative clinical evaluation, spirometry, arterial gasometry, and simple chest X-rays. Results: The incidence of PPC was 7.5% in the rehabilitation group and 19.5% in the control group; the control group also had more radiologic alterations (p = .01). Stratified PPC analysis did not reveal significant differences between groups. However, high-and moderate-risk patients in the rehabilitation group had fewer PPC, Multivariate analysis showed a greater PPC risk associated with pulmonary history (p = .02) and duration of surgery longer than 120 min (p = .03), while rehabilitation exerted a protective effect (p = .06). Significant postoperative decreases in pulmonary volumes and arterial gas values were recorded in both groups, without significant differences. Conclusions: Respiratory rehabilitation protects against PPC and is more effective in moderate-and high-risk patients, but does not affect surgery-induced functional alterations. (C) 1998 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.