1. Ultra-early initiation of postoperative rehabilitation in the post-anaesthesia care unit after major thoracic surgery: case-control study
- Author
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Pastene, Bruno, Labarriere, Ambroise, Lopez, Alexandre, Charvet, Aude, Culver, Aurélien, Fiocchi, David, Cluzel, Armand, Brioude, Geoffrey, Einav, Sharon, Tankel, James, Hamidou, Zeinab, D’journo, Xavier Benoit, Thomas, Pascal, Leone, Marc, Zieleskiewicz, Laurent, Slim, K., Joris, J., Delaunay, L., Regimbeau, J-M., Ostermann, S., Beyer-Berjot, L., Lavand'Homme, P., Lafortune, I., Szymkiewicz, O., Venara, A., Zieleskiewicz, L., Puppo, N., Beaupère, S., Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), CHU Marseille, Aix-Marseille Université - École de médecine (AMU SMPM MED), Aix-Marseille Université - Faculté des sciences médicales et paramédicales (AMU SMPM), Aix Marseille Université (AMU)-Aix Marseille Université (AMU), Hôpital Nord [CHU - APHM], The Hebrew University of Jerusalem (HUJ), McGill University = Université McGill [Montréal, Canada], Centre d'études et de recherche sur les services de santé et la qualité de vie (CEReSS), Aix Marseille Université (AMU), Hôpital de la Timone [CHU - APHM] (TIMONE), CHU Clermont-Ferrand, Centre Hospitalier Universitaire de Liège (CHU-Liège), Clinique Générale Annecy, CHU Amiens-Picardie, Université de Genève = University of Geneva (UNIGE), Cliniques Universitaires Saint-Luc [Bruxelles], Hospices Civils de Lyon (HCL), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU d'Angers [Département Urgences], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Hôpital Saint-Joseph [Marseille], UNICANCER, and Lucas, Nelly
- Subjects
Pulmonary Atelectasis ,Postoperative Complications ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,[SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery ,Case-Control Studies ,Humans ,Thoracic Surgery ,Anesthesia ,General Medicine ,[SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery ,Pneumonia ,[SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system - Abstract
Background Physiotherapy is a major cornerstone of enhanced rehabilitation after surgery (ERAS) and reduces the development of atelectasis after thoracic surgery. By initiating physiotherapy in the post-anaesthesia care unit (PACU), the aim was to evaluate whether the ultra-early initiation of rehabilitation (in the first hour following tracheal extubation) would improve the outcomes of patients undergoing elective thoracic surgery. Methods A case–control study with a before-and-after design was conducted. From a historical control group, patients were paired at a 3:1 ratio with an intervention group. This group consisted of patients treated with the ultra-early rehabilitation programme after elective thoracic surgery (clear fluids, physiotherapy, and ambulation). The primary outcome was the incidence of postoperative atelectasis and/or pneumonia during the hospital stay. Results After pairing, 675 patients were allocated to the historical control group and 225 patients to the intervention group. A significant decrease in the incidence of postoperative atelectasis and/or pneumonia was found in the latter (11.4 versus 6.7 per cent respectively; P = 0.042) and remained significant on multivariate analysis (OR 0.53, 95 per cent c.i. 0.26 to 0.98; P = 0.045). A subgroup analysis of the intervention group showed that early ambulation during the PACU stay was associated with a further significant decrease in the incidence of postoperative atelectasis and/or pneumonia (2.2 versus 9.5 per cent; P = 0.012). Conclusions Ultra-early rehabilitation in the PACU was associated with a decrease in the incidence of postoperative atelectasis and/or pneumonia after major elective thoracic surgery.
- Published
- 2022