Preoperative intervention reduces postoperative pulmonary complications but not length of stay in cardiac surgical patients: a systematic review

David Snowdon; Terry P Haines; Elizabeth H Skinner

doi:10.1016/j.jphys.2014.04.002

Preoperative intervention reduces postoperative pulmonary complications but not length of stay in cardiac surgical patients: a systematic review

J Physiother. 2014 Jun;60(2):66-77. doi: 10.1016/j.jphys.2014.04.002. Epub 2014 Jun 10.

Authors

David Snowdon¹, Terry P Haines², Elizabeth H Skinner³

Affiliations

¹ Department of Physiotherapy, Monash Medical Centre.
² Allied Health Research Unit, Monash Health.
³ Department of Physiotherapy, Monash Medical Centre; Allied Health Research Unit, Monash Health; Department of Physiotherapy, Monash Health, Western Health, Melbourne, Australia.

PMID: 24952833
DOI: 10.1016/j.jphys.2014.04.002

Abstract

Question: Does preoperative intervention in people undergoing cardiac surgery reduce pulmonary complications, shorten length of stay in the intensive care unit (ICU) or hospital, or improve physical function?

Design: Systematic review with meta-analysis of (quasi) randomised trials.

Participants: People undergoing coronary artery bypass grafts and/or valvular surgery.

Intervention: Any intervention, such as education, inspiratory muscle training, exercise training or relaxation, delivered prior to surgery to prevent/reduce postoperative pulmonary complications or to hasten recovery of function.

Outcome measures: Time to extubation, length of stay in ICU and hospital (reported in days). Postoperative pulmonary complications and physical function were measured as reported in the included trials.

Results: The 17 eligible trials reported data on 2689 participants. Preoperative intervention significantly reduced the time to extubation (MD -0.14 days, 95% CI -0.26 to -0.01) and the relative risk of developing postoperative pulmonary complications (RR 0.39, 95% CI 0.23 to 0.66). However, it did not significantly affect the length of stay in ICU (MD -0.15 days, 95% CI -0.37 to 0.08) or hospital (MD -0.55 days, 95% CI -1.32 to 0.23), except among older participants (MD -1.32 days, 95% CI -2.36 to -0.28). When the preoperative interventions were separately analysed, inspiratory muscle training significantly reduced postoperative pulmonary complications and the length of stay in hospital. Trial quality ranged from good to poor and considerable heterogeneity was present in the study features. Other outcomes did not significantly differ.

Conclusion: For people undergoing cardiac surgery, preoperative intervention reduces the incidence of postoperative pulmonary complications and, in older patients, the length of stay in hospital.

Keywords: Cardiac surgical procedures; Coronary artery bypass; Education; Preoperative care; Rehabilitation.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Aged
Breathing Exercises
Cardiac Valve Annuloplasty*
Cardiovascular Diseases / surgery
Coronary Artery Bypass*
Female
Hospitals / statistics & numerical data
Humans
Incidence
Length of Stay / statistics & numerical data*
Male
Middle Aged
Patient Education as Topic
Postoperative Complications / epidemiology*
Postoperative Complications / prevention & control*
Preoperative Care / methods*
Respiratory Insufficiency / epidemiology
Respiratory Insufficiency / prevention & control
Respiratory Tract Infections / epidemiology
Respiratory Tract Infections / prevention & control
Treatment Outcome