The effect of postoperative respiratory and mobilization interventions on postoperative complications following abdomina
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REVIEW ARTICLE
The effect of postoperative respiratory and mobilization interventions on postoperative complications following abdominal surgery: a systematic review and meta‑analysis Dunja Kokotovic1,2 · Adam Berkfors1 · Ismail Gögenur1 · Sarah Ekeloef1 · Jakob Burcharth1 Received: 27 August 2020 / Accepted: 29 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Up to 30% of patients undergoing abdominal surgery suffer from postoperative pulmonary complications. The purpose of this systematic review and meta-analyses was to investigate whether postoperative respiratory interventions and mobilization interventions compared with usual care can prevent postoperative complications following abdominal surgery. Methods The review was conducted in line with PRISMA and GRADE guidelines. MEDLINE, Embase, and PEDRO were searched for randomized controlled trials and observational studies comparing postoperative respiratory interventions and mobilization interventions with usual care in patients undergoing abdominal surgery. Meta-analyses with trial sequential analysis on the outcome pulmonary complications were performed. Review registration: PROSPERO (identifier: CRD42019133629) Results Pulmonary complications were addressed in 25 studies containing 2068 patients. Twenty-three studies were included in the meta-analyses. Patients predominantly underwent open elective upper abdominal surgery. Postoperative respiratory interventions consisted of expiratory resistance modalities (CPAP, EPAP, BiPAP, NIV), assisted inspiratory flow modalities (IPPB, IPAP), patient-operated ventilation modalities (spirometry, PEP), and structured breathing exercises. Meta-analyses found that ventilation with high expiratory resistance (CPAP, EPAP, BiPAP, NIV) reduced the risk of pulmonary complications with OR 0.42 (95% CI 0.18–0.97, p = 0.04, I2 = 0%) compared with usual care, however, the trial sequential analysis revealed that the required information size was not met. Neither postoperative assisted inspiratory flow therapy, patientoperated ventilation modalities, nor breathing exercises reduced the risk of pulmonary complications. Conclusion The use of postoperative expiratory resistance modalities (CPAP, EPAP, BiPAP, NIV) after abdominal surgery might prevent pulmonary complications and it seems the preventive abilities were largely driven by postoperative treatment with CPAP. Keywords Complications · Physiotherapy · Ventilation · CPAP
Introduction Results Were Presented As an Oral Presentation At the Danish Surgical Society Meeting October 31 2019. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00068-020-01522-x) contains supplementary material, which is available to authorized users. * Dunja Kokotovic [email protected] 1
Center for Surgical Science, Department of Surgery, Zealand University Hospital and Copenhagen University, Lykkebækvej 1, 4600 Køge, Denmark
Platanvej 5, 1810 Frederiksberg C, Denmark
2
Postoperati
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