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

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.

Effectiveness of Preoperative Incentive Spirometry in Patients Following Elective Thoracotomy for Prevention of Postoperative Pulmonary Complication

Background: Thoracotomy can cause postoperative impairment of respiratory function and highly risk turns as Postoperative Pulmonary Complication (PPC). One of strategies to decrease risk of PPC in preoperative evaluation is lung expansion maneuvers include Incentive Spirometry (IS). Incentive Spirometry was breathing technique that sustained maximal inspiration, using device which give visual feedback. This study aims to know effectiveness of using preoperative IS in reducing incidence of PPC in thoracotomy patients. Methods: Experimental study with post test only design. Comparing emerged PPC with Melbourne Group Scale Version 2 (MDG-2) criteria in elective posterolateral thoracotomy patients who given IS and non IS preoperative. Data were analyzed using chi square test. Results: Total samples was 32 patients. There was 11 patients had PPC, which 6 recieved IS preoperatively. There was no relation between PPC with age, sex, height, smoking history proportion (p value>0,05). Chi square test showed there was no relation between using IS preoperative and PPC incidence(p>0,710). Conclusions: IS preoperative was not effective in preventing PPC in elective thoracotomy patients.

1015 Elective Cancer Surgery In COVID-19 Free Surgical Pathways During The SARS-Cov-2 Pandemic: An International, Multi-Centre, Comparative Cohort Study

Introduction This study aimed to determine whether COVID-19 free surgical pathways were associated with lower postoperative pulmonary complication rates compared to hospitals with no defined pathway. Method This international multi-centre cohort study included patients undergoing elective surgery for 10 solid cancer types, without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until 19 April 2020. At the time of surgery, hospitals were defined as having a COVID-19 free surgical pathway (complete segregation of the operating theatre, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with COVID-19 patients). The primary outcome was 30-day postoperative pulmonary complications. Results Of 9171 patients from 447 hospitals in 55 countries, 2481 were operated in COVID-19 free surgical pathways. After adjustment, pulmonary complication rates were lower with COVID-19 free surgical pathways (2.2% versus 4.9%, OR: 0.62 [0.44-0.86]). This was consistent in sensitivity analyses and a propensity-score matched model. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19 free surgical pathways (2.1% versus 3.6%; OR 0.53 [0.36-0.76]). Conclusions Within available resources, dedicated COVID-19 free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks.

PREDICTIVE FACTORS OF INCISIONAL HERNIA AFTER NEPHRECTOMY

INTRODUCTION Kidney diseases’ surgical approach is multiple, tending to reduce postoperative complications such as incisional hernia, a complication with an incidence around 5-15% and which usually appears after the first year of surgery, being this the possible trigger of serious pathologies that make essential the need to identify predictive factors of its appearance. MATERIAL AND METHODS A retrospective observational study was carried out in 269 patients undergoing nephrectomy (partial or radical) or nephroureterectomy between 2004 and 2018, with the aim of identifying possible predictive factors of incisional hernia after these surgeries. Preoperative (epidemiological and comorbidities), intraoperative (type of surgery, approach and closure, duration) and postoperative data (different possible complications) were taken into account. A univariate and multivariate analysis were performed, using Chi-square test and logistic regression, respectively. RESULTS The median follow-up time was 52.2 months (SD = 39.5), time in which 22 patients had an incisional hernia (8.2%), showing this association with preoperative and postoperative variables. As preoperative data COPD, obesity, ASA and a history of previous laparotomy were related in the univariate analysis, while only obesity was associated in the multivariate analysis (p = 0.003); among postoperative items surgical wound infection, postoperative pulmonary complication, seroma and the need for transfusion and reoperation showed association in the univariate analysis, but only surgical wound infection was the one confirmed in the multivariate analysis (p = 0.049). CONCLUSIONS Obesity and surgical wound infection were proved to be the main predictive factors for the appearance of incisional hernia after nephrectomy.

Elective Cancer Surgery in COVID-19–Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks.

Effect of Additional Threshold Inspiratory Muscle Training Preoperative on Pulmonary Complication Post Heart Valve Replacement Surgery

ABSTRACT Introduction: Cardiac surgery has been improved patient’s outcome with cardiac valve anomaly. There was 111 cardiac valve replacement surgery performed in Kariadi General Hospital Semarang in 2018.Postoperative pulmonary complication (PPC) is the most common complication in this procedure compared to cardiac complication which are thought caused by the disruption of normal respiratory function as a result from surgical and anesthetic procedure. Additional preoperative threshold inspiratory muscle training (Threshold IMT) has been considered as an ef fective intervention to reduce PPC. Methods: This is a quasi experimental study with main reason to know the role of Threshold IMT on PPC incidences. Subjects in the intervention group were given routine conventional rehabilitationexercises according to Clinical Practice Guide (PPK) with additional of Threshold IMT, which applied based on research protocols, while control group did convention al rehabilitation exercises only. Results: 18 subjects were divided into intervention group (n=9), and control group (n=9), PPC incidences (Intervention group n=2, control group n=7) were analyzed statistically using Chi-squared test andshowed significant differences (Fisher exact test p=0.02 with α=0.05). Conclusion: Additional of Threshold IMT preoperative may reduce the incidence of PPC on heart valve replacement surgery.Keywords: Postoperative pulmonary complication (PPC), Threshold inspiratory muscle training (Threshold IMT)