scholarly journals Is respiratory physiotherapy effective on pulmonary complications after lobectomy for lung cancer?

2020 ◽  
Vol 28 (4) ◽  
pp. 638-647
Author(s):  
Hüseyin Ulaş Çınar
Keyword(s):  
Lung Cancer ◽  
Hospital Stay ◽  
Hospital Cost ◽  
Multivariate Logistic Regression Analysis ◽  
Length Of Hospital Stay ◽  
Pulmonary Complications ◽  
Total Hospital Cost ◽  
Postoperative Pulmonary Complications ◽  
Physiotherapy Program ◽  
Respiratory Physiotherapy

Background: The aim of this study was to investigate the effects of a postoperative respiratory physiotherapy program on pulmonary complications, length of hospital stay, and hospital cost after lobectomy for lung cancer. Methods: A total of 90 patients (75 males, 15 females; mean age 63.1±10.4 years; range, 30 to 82 years) who underwent elective lobectomy through thoracotomy due to lung cancer between June 2014 and December 2019 were retrospectively analyzed. The patients were divided into two groups as Group S who received standard postoperative care (n=50) and Group P who received postoperative respiratory physiotherapy in addition to standard care (n=40). Both groups were compared in terms of postoperative pulmonary complications, 30-day mortality, length of hospital stay, and hospital cost. Results: The preoperative and surgical characteristics of the groups were similar. Group P had a lower incidence of postoperative pulmonary complications (10% vs. 38%, respectively; p=0.002) than Group S. The median length of stay in the hospital was six (range, 4 to 12) days in Group P and seven (range, 4 to 40) days in Group S (p=0.001). The drug cost (639.70 vs. 1,211.46 Turkish Liras, respectively; p=0.001) and the total hospital cost (2,031.10 vs. 3,778.68 Turkish Liras, respectively; p=0.001) of the patients in Group P were significantly lower. The multivariate logistic regression analysis showed that respiratory physiotherapy had a protective effect on the development of postoperative pulmonary complications (odds ratio =0.063, 95% confidence interval: 0.010-0.401, p=0.003). Conclusion: An intensive physiotherapy program focusing on respiratory exercises is a cost-effective practice which reduces the risk of development of postoperative pulmonary complications in patients undergoing lobectomy for lung cancer.

The effectiveness of pre- and post-operative rehabilitation for lung cancer: A systematic review and meta-analysis on postoperative pulmonary complications and length of hospital stay

2021 ◽  
pp. 026921552110432
Author(s):  
Xinyi Xu ◽  
Denise Shuk Ting Cheung ◽  
Robert Smith ◽  
Agnes Yuen Kwan Lai ◽  
Chia-Chin Lin
Keyword(s):  
Lung Cancer ◽  
Hospital Stay ◽  
Pulmonary Complication ◽  
Length Of Hospital Stay ◽  
Pulmonary Complications ◽  
Hospital Length Of Stay ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Postoperative Pulmonary Complication ◽  
Postoperative Pulmonary Complications

Objective: To investigate the effects of rehabilitation either before or after operation for lung cancer on postoperative pulmonary complications and the length of hospital stay. Data sources: MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL Plus, SPORTDiscus, PsycInfo and Embase were searched from inception until June 2021. Review methods: Inclusion criteria were patients scheduled to undergo or had undergone operation for lung cancer, randomised controlled trials comparing rehabilitative interventions initiated before hospital discharge to usual care control. Two reviewers independently assessed eligibility, extracted data and risks of bias. Pooled odds ratios (ORs) or standardised mean differences (SMDs) with 95% Confidence Intervals (CI) were estimated using random-effects meta-analyses. Results: Twenty-three studies were included (12 preoperative, 10 postoperative and 1 perioperative), with 2068 participants. The pooled postoperative pulmonary complication risk and length of hospital stay were reduced after preoperative interventions (OR = 0.32; 95% CI = 0.22, 0.47; I2 = 0.0% and SMD = −1.68 days, 95% CI = −2.23, −1.13; I2 = 77.8%, respectively). Interventions delivered during the immediate postoperative period did not have any significant effects on either postoperative pulmonary complication or length of hospital stay (OR = 0.85; 95% CI = 0.56, 1.29; I2 = 0.0% and SMD = −0.23 days, 95% CI = −1.08, 0.63; I2 = 64.6%, respectively). Meta-regression showed an association between a higher number of supervised sessions and shorter hospital length of stay in preoperative studies (β = −0.17, 95% CI = −0.29, −0.05). Conclusion: Preoperative rehabilitation is effective in reducing postoperative pulmonary complications and length of hospital stay associated with lung cancer surgery. Short-term postoperative rehabilitation in inpatient settings is probably ineffective.

scholarly journals PREDICTION VALUE OF OXYGENATION INDEX AS PREDICTOR FOR POSTOPERATIVE PULMONARY COMPLICATIONS IN UROLOGIC SURGERY

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Maja Mojsova Mijovska ◽  
Aleksandra Gavrilovska- Brzanov ◽  
Marija Jovanovski Srceva ◽  
Zuzanne Ehmer Nelepa ◽  
Nikola Brzanov
Keyword(s):  
Mechanical Ventilation ◽  
Hospital Stay ◽  
Multivariate Logistic Regression Analysis ◽  
Length Of Hospital Stay ◽  
Oxygenation Index ◽  
Pulmonary Complications ◽  
Arterial Oxygen ◽  
Postoperative Pulmonary Complications ◽  
Oxygenation Status ◽  
Endotracheal Anesthesia

Introduction: It is believed that pressure/flow (P/F) ratio (arterial oxygen to inspired oxygen fraction) does not give the best expression of oxygenation status in mechanically ventilated patients. Therefore, a new oxygenation index (OI) where the mean airway pressure (MAP) is incorporated (PaO2/FiOxMAP) is showed as superior to P/F in expression of the lung oxygenation status. In this article we wanted to assess the prediction value of OI calculated during urological surgeries as a predictive marker for developing postoperative pulmonary complications (PPC). Material and methods: We evaluated all elective urologic patients operated in general endotracheal anesthesia, aged 18 to 65 years, without any known history of respiratory disease for the period from January till December 2017. We calculated the P/F ratio and the OI at three time points: after induction in general endotracheal anesthesia in the beginning of mechanical ventilation, 1 hour after induction in anesthesia, and at the end of the surgery before weaning the mechanical ventilation. The primary outcomes were PPC defined by European Society of Anesthesia. The second outcomes were: length of hospital stay, admission to intensive care unit (ICU) and mortality.   Results: A total of 240 patients who met the inclusion criteria were included in this evaluation and finally analyzed. PPC were diagnosed in 25% of patients and respectively 75% were without complications. Postoperative hospital stay was longer in PPC group no matter they were operated laparoscopically or with classic open surgery (PPC laparoscopy 4.9 ± 2.2 vs. non PPC laparoscopy 3.3 ± 1.7, PPC laparotomy 6.8 ± 5.2 vs. non PPC 5.6 ± 2.1 laparotomy). Ten patients were admitted to ICU, 8 from PPC group and 2 from non PPC group. In PPC group patients were admitted to ICU for mean 3.7 ± 2.4 days, and in non PPC group patients were hospitalized in ICU only for 2 days. All evaluated patients were discharged from the hospital and no mortality was observed in the 30 postoperative days. In the univariate and multivariate logistic regression analysis neither OI nor P/F were significantly associated with PPC. Conclusion:  This study does not offer a conclusive answer to the prediction value of OI for PPC. It would be fruitful to pursue further research about predictive variables for pulmonary complications.

scholarly journals Influence of Enhanced Recovery After Surgery (ERAS) on Patients Receiving Lung Resection: A Retrospective Study with 1,749 Cases

2020 ◽  
Author(s):  
Chunmei Wang ◽  
Yutian Lai ◽  
Pengfei Li ◽  
Jianhua Su ◽  
Guowei Che
Keyword(s):  
Lung Cancer ◽  
Logistic Regression ◽  
Hospital Cost ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Lung Resection ◽  
Lung Cancer Surgery ◽  
Pulmonary Complications ◽  
Hospital Length Of Stay ◽  
Postoperative Pulmonary Complications

Abstract Background the study was aimed to evaluate the outcomes following implementation of enhanced recovery after surgery (ERAS) in patients undergoing lung cancer surgery.Method a retrospective cohort study with 1,749 patients with lung cancer undergoing pulmonary resection was conducted. Two time period of the patients were included for analyzing (routine pathway and ERAS pathway). Logistic regression analysis and nomogram model was created respectively to assess the risks of postoperative pulmonary complications.Results Among those 1,749 patients, 691 of them was stratified into ERAS group, compared to 1,058 in routine group. ERAS group presented shorter postoperative in-hospital length of stay (LOS) (4.0 vs 6.0, P<0.001), total LOS (10.0 VS. 13.0 days, P<0.001), lower total in-hospital cost (P<0.001) including material (P<0.001), and drug expense (P<0.001). Meanwhile, ERAS group presented lower occurrence of postoperative pulmonary complications (PPCs) compared to routine group (15.2% vs. 19.5%, P=0.022). Likewise, a significantly lower occurrence of pneumonia (8.4% vs. 14.2%, P<0.001) or atelectasis (5.9% vs. 9.8%, P=0.004) was found in ERAS group. Regarding to Binary logistic regression, ERAS intervention was the independent factor for the occurrence of PPCs (OR: 0.601, 95%CI: 0.434-0.824, P=0.002). In addition, age (OR: 1.032, 95%CI: 1.018-1.046), COPD (OR: 1.792, 95%CI: 1.196-2.686), and FEV1(OR: 0.205, 95%CI: 0.125-0.339) were independent predictors for PPCs. A nomogram with a C-index of 0.663 was constructed.Conclusion implementation of an ERAS pathway shows improved postoperative outcomes including shortened LOS, less in-hospital cost, and reduced occurrence of PPCs, providing benefits of postoperative recovery for patients with lung cancer undergoing surgical treatment.Clinical registration number: ChiCTR1900022478

666 EARLY EXTUBATION AFTER ESOPHAGECTOMY IS SAFE. A SYSTEMATIC REVIEW AND META-ANALYSIS

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Maria Serafim ◽  
Clara Santos ◽  
Marina Orlandini ◽  
Letícia Datrino ◽  
Guilherme Tavares ◽  
...  
Keyword(s):  
Systematic Review ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Risk Difference ◽  
Pulmonary Complications ◽  
Mean Difference ◽  
Early Extubation ◽  
Icu Length Of Stay ◽  
Anastomotic Fistula

Abstract   Esophagectomy has high morbidity and mortality, mainly due to pulmonary complications. Consequently, ventilatory support is a cornerstone in postoperative management. However, there is still no consensus on the timing for extubation. There is a fear that untimely extubation would lead to a high risk for an urgent reintubation. On the other hand, there is a risk for pulmonary damage in prolonged intubation. Thus, the present study aimed to compare early and late extubation after esophagectomy. Methods A systematic review was carried out on PubMed, Lilacs, Cochrane Library Central, and Embase, comparing early and late extubation after esophagectomy. The primary outcome was reintubation. Secondary outcomes included mortality; complications; pulmonary complications; pneumonia; anastomotic fistula; length of hospital stay; and ICU length of stay. The inclusion criteria were: a) clinical trials and cohort studies; b) adult patients (&gt; 18 years); and c) patients with esophageal cancer undergoing esophagectomy. The results were summarized by risk difference and mean difference. 95% confidence interval and random model were applied. Results Four articles were selected, comprising 490 patients. Early extubation did not increase the risk for reintubation, with a risk difference of 0.01 (95%CI -0.03; 0.04). Also, there was no difference for mortality −0.01 (95%CI -0.04; 0.03); complications −0.09 (95%CI -0.22; 0.05); pulmonary complications −0.05 (95%CI -0.13; 0.03); pneumonia −0.06 (95% CI-0.18; 0.05); anastomotic fistula −0.01 (95% CI -0.09; 0.08). In addition, there was no significant mean difference for: length of hospital stay −0.10 (95%CI -0.38; 0.1); and ICU length of stay 0.00 (95%CI -0.22; 0.22). Conclusion Early extubation after esophagectomy does not increase the risk for reintubation, mortality, complications, and lenght of stay.

scholarly journals Prediction of Postoperative Pulmonary Complications Using Preoperative Controlling Nutritional Status (CONUT) Score in Patient with Resectable Non-small Cell Lung Cancer (P12-032-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Ah Young Leem ◽  
Ji Ye Jung ◽  
Sang Chul Lee ◽  
Eun Young Kim ◽  
Sang Hoon Lee ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Nutritional Status ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Pulmonary Complications ◽  
Small Cell ◽  
Postoperative Pulmonary Complications ◽  
Small Cell Lung ◽  
Prolonged Air Leak ◽  
Conut Score

Abstract Objectives Postoperative pulmonary complications (PPCs) significantly impact surgical outcome, but the clinical usefulness of various models used to predict PPCs is questionable. The controlling nutritional status (CONUT) score reflects nutritional deficiency and inflammation and is used to predict clinical outcomes in various malignancies. We aimed to investigate the ability of the CONUT score to predict PPCs after lung resection in patients with non-small cell lung cancer (NSCLC). Methods We retrospectively reviewed data of 922 patients with NSCLC who underwent complete resection at Severance Hospital in South Korea during January 2016–December 2017. We analyzed the predictability of the CONUT score for PPCs compared with other inflammatory prognostic markers and PPCs risk scoring systems (prognostic nutritional index [PNI], Glasgow prognostic score [GPS], and assessment of respiratory risk in surgical patients in Catalonia [ARISCAT] score) using receiver operating characteristic curves analysis. Results Of 922 study subjects, 522 (56.6%) were male; the mean age was 64.2 years. Lobectomy was the most common type of operation (n = 737, 79.9%). Total incidence of PPCs was 8.6% (n = 79). Prolonged air leak (44.3%) was the most common PPC, followed by pneumonia (32.9%) and pneumothorax (11.4%). The proportion of pneumonia was significantly larger in the high CONUT group (P < 0.05). The CONUT consistently had a higher area under curve (AUC) value (0.64) than other prognostic models (PNI: AUC = 0.61, GPS: AUC = 0.57, and ARISCAT: AUC = 0.54). Multivariate analysis identified male sex (odds ratio [OR] = 1.94), low body mass index (OR = 4.57), and high CONUT score (OR = 1.91) as independent PPCs prognostic factors. Kaplan-Meier analysis revealed a significantly higher 1-year mortality rate for the high CONUT group (hazard ratio = 7.97; 95% confidence interval, 1.78–35.59). Conclusions Preoperative CONUT score is an independent predictor of PPCs and 1-year mortality in patients with NSCLC. Funding Sources None.

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