Effect of Incentive Spirometry on Postoperative Hypoxemia and Pulmonary Complications After Bariatric Surgery

Background: Currently, consensus on the effectiveness of incentive spirometry (IS) following cardiac, thoracic, and upper abdominal surgery has been based on randomized controlled trials (RCTs) and systematic reviews of lower methodological quality. To improve the quality of the research and to account for the effects of IS following thoracic surgery, in addition to cardiac and upper abdominal surgery, we performed a meta-analysis with thorough application of the Grading of Recommendations Assessment, Development and Evaluation scoring system and extensive reference to the Cochrane Handbook for Systematic Reviews of Interventions. Objective: The objective of this study was to determine, with rigorous methodology, whether IS for adult patients (18 years of age or older) undergoing cardiac, thoracic, or upper abdominal surgery significantly reduces30-day post-operative pulmonary complications (PPCs), 30-day mortality, and length of hospital stay (LHS) when compared to other rehabilitation strategies. Methods: The literature was searched using Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and Web of Science for RCTs between the databases’ inception and March 2019. A random-effect model was selected to calculate risk ratios (RRs) with 95% confidence intervals (CIs). Results: Thirty-one RCTs involving 3,776 adults undergoing cardiac, thoracic, or upper abdominal surgery were included. By comparing the use of IS to other chest rehabilitation strategies, we found that IS alone did not significantly reduce 30-day PPCs (RR = 1.00, 95% CI: 0.88–1.13) or 30-day mortality (RR = 0.73, 95% CI: 0.42–1.25). Likewise, there was no difference in LHS (mean difference = −0.17,95% CI: −0.65 to 0.30) between IS and the other rehabilitation strategies. None of the included trials significantly impacted the sensitivity analysis and publication bias was not detected. Conclusions: This meta-analysis showed that IS alone likely results in little to no reduction in the number of adult patients with PPCs, in mortality, or in the LHS, following cardiac, thoracic, and upper abdominal surgery.

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Are Incentive Spirometry, Intermittent Positive Pressure Breathing, and Deep Breathing Exercises Effective in the Prevention of Postoperative Pulmonary Complications After Upper Abdominal Surgery? A Systematic Overview and Meta-analysis

Physical Therapy ◽

10.1093/ptj/74.1.3 ◽

1994 ◽

Vol 74 (1) ◽

pp. 3-10 ◽

Cited By ~ 118

Author(s):

Jackie A Thomas ◽

John M McIntosh

Keyword(s):

Abdominal Surgery ◽

Meta Analysis ◽

Pulmonary Complications ◽

Positive Pressure ◽

Deep Breathing ◽

Postoperative Pulmonary Complications ◽

Breathing Exercises ◽

Upper Abdominal ◽

Intermittent Positive Pressure Breathing ◽

Incentive Spirometry

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Incentive spirometry to prevent pulmonary complications after chest trauma: a retrospective observational study

Acute Medicine & Surgery ◽

10.1002/ams2.619 ◽

2020 ◽

Vol 7 (1) ◽

Author(s):

Hisashi Dote ◽

Yohichiro Homma ◽

Masaaki Sakuraya ◽

Hiraku Funakoshi ◽

Shigeru Tanaka ◽

...

Keyword(s):

Observational Study ◽

Chest Trauma ◽

Pulmonary Complications ◽

Retrospective Observational Study ◽

Incentive Spirometry

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Preoperative multidisciplinary program for bariatric surgery: a proposal for the Brazilian Public Health System

Arquivos de Gastroenterologia ◽

10.1590/s0004-2803.2017v54n1-14 ◽

2017 ◽

Vol 54 (1) ◽

pp. 70-74 ◽

Cited By ~ 16

Author(s):

Elinton Adami CHAIM ◽

José Carlos PAREJA ◽

Martinho Antonio GESTIC ◽

Murillo Pimentel UTRINI ◽

Everton CAZZO

Keyword(s):

Public Health ◽

Bariatric Surgery ◽

Health System ◽

Public Health System ◽

Wound Dehiscence ◽

Pulmonary Complications ◽

Multidisciplinary Program ◽

The Impact ◽

Access To Surgery

ABSTRACT BACKGROUND Bariatric surgery has become the gold standard treatment for morbid obesity, but access to surgery remains difficult and low compliance to postoperative follow-up is common. To improve outcomes, enable access and optimize follow-up, we developed a multidisciplinary preoperative approach for bariatric surgery. OBJECTIVE To determine the impact of this program in the outcomes of bariatric surgery in the Brazilian public health system. METHODS A prospective evaluation of the individuals who underwent a preoperative multidisciplinary program for bariatric surgery and comparison of their surgical outcomes with those observed in the prospectively collected historical database of the individuals who underwent surgery before the beginning of the program. RESULTS There were 176 individuals who underwent the multidisciplinary program and 226 who did not. Individuals who underwent the program had significantly lower occurrence of the following variables: hospital stay; wound dehiscence; wound infection; pulmonary complications; anastomotic leaks; pulmonary thromboembolism; sepsis; incisional hernias; eventrations; reoperations; and mortality. Both loss of follow-up and weight loss failure were also significantly lower in the program group. CONCLUSION The adoption of a comprehensive preoperative multidisciplinary approach led to significant improvements in the postoperative outcomes and also in the compliance to the postoperative follow-up. It represents a reproducible and potentially beneficial approach within the context of the Brazilian public health system.

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