[en] [en] 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.
Disciplines :
General & internal medicine
Author, co-author :
Pastene, Bruno ; Department of Anaesthesiology and Intensive Care Medicine, Hôpital Nord, Hôpitaux Universitaires de Marseille, Aix Marseille University, Marseille, France ; Centre for Cardiovascular and Nutrition Research (C2VN), INRA, Aix Marseille Université, INSERM, Marseille, France
Labarriere, Ambroise; Department of Anaesthesiology and Intensive Care Medicine, Hôpital Nord, Hôpitaux Universitaires de Marseille, Aix Marseille University, Marseille, France
Lopez, Alexandre; Department of Anaesthesiology and Intensive Care Medicine, Hôpital Nord, Hôpitaux Universitaires de Marseille, Aix Marseille University, Marseille, France
Charvet, Aude; Department of Anaesthesiology and Intensive Care Medicine, Hôpital Nord, Hôpitaux Universitaires de Marseille, Aix Marseille University, Marseille, France
Culver, Aurélien; Department of Anaesthesiology and Intensive Care Medicine, Hôpital Nord, Hôpitaux Universitaires de Marseille, Aix Marseille University, Marseille, France
Fiocchi, David; Department of Anaesthesiology and Intensive Care Medicine, Hôpital Nord, Hôpitaux Universitaires de Marseille, Aix Marseille University, Marseille, France
Cluzel, Armand; Department of Thoracic Surgery, Hôpital Nord, Hôpitaux Universitaires de Marseille, Aix Marseille University, Marseille, France
Brioude, Geoffrey; Department of Thoracic Surgery, Hôpital Nord, Hôpitaux Universitaires de Marseille, Aix Marseille University, Marseille, France
Einav, Sharon; Intensive Care Unit of the Shaare Zedek Medical Medical Centre, Hebrew University Faculty of Medicine, Jerusalem, Israel
Tankel, James ; Division of Thoracic Surgery, McGill University Health Centre, Montreal, Quebec, Canada
Hamidou, Zeinab; Centre d'Études et de Recherches sur les Services de Santé et Qualité de Vie CEReSS/EA 3279, Hôpitaux Universitaires de Marseille, Aix Marseille University, Marseille, France
D'Journo, Xavier Benoit ; Department of Thoracic Surgery, Hôpital Nord, Hôpitaux Universitaires de Marseille, Aix Marseille University, Marseille, France
Thomas, Pascal; Department of Thoracic Surgery, Hôpital Nord, Hôpitaux Universitaires de Marseille, Aix Marseille University, Marseille, France
Leone, Marc; Department of Anaesthesiology and Intensive Care Medicine, Hôpital Nord, Hôpitaux Universitaires de Marseille, Aix Marseille University, Marseille, France ; Centre for Cardiovascular and Nutrition Research (C2VN), INRA, Aix Marseille Université, INSERM, Marseille, France
Zieleskiewicz, Laurent; Department of Anaesthesiology and Intensive Care Medicine, Hôpital Nord, Hôpitaux Universitaires de Marseille, Aix Marseille University, Marseille, France ; Centre for Cardiovascular and Nutrition Research (C2VN), INRA, Aix Marseille Université, INSERM, Marseille, France ; Department of Digestive and Hepatobiliary Surgery, CHU Estaing, Clermont-Ferrand, France
GRACE Association
Joris, Jean ; Université de Liège - ULiège > Département des sciences de la santé publique
Berna P, Quesnel C, Assouad J, Bagan P, Etienne H, FourdrainAet al. Enhanced Recovery After Pulmonary Lobectomy-RFE commune SFAR- SFCTCV. https://sfar.org/download/rfe-anesthesie-rac-lobectomiepulmonaire/? wpdmdl=24440&refresh=5f3a5824dcfd41597659172 (accessed 8 July 2020)
Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E Brunelli A, Cerfolio RJ, Gonzalez M et al. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg 2019;55:91-115
Ziarnik E, Grogan EL. Postlobectomy early complications. Thorac Surg Clin 2015;25:355-364
Seely AJE, Ivanovic J, Threader J, Al-Hussaini A, Al-Shehab D, Ramsay T et al. Systematic classification of morbidity and mortality after thoracic surgery. Ann Thorac Surg 2010;90:936-942
Van Haren RM, Mehran RJ, Mena GE, Correa AM, Antonoff MB, Baker CM et al. Enhanced recovery decreases pulmonary and cardiac complications after thoracotomy for lung cancer. Ann Thorac Surg 2018;106:272-279
Boden I, Skinner EH, Browning L, Reeve J, Anderson L, Hill C et al. Preoperative physiotherapy for the prevention of respiratory complications after upper abdominal surgery: pragmatic, double blinded, multicentre randomised controlled trial. BMJ 2018;360:j5916
Zieleskiewicz L, Papinko M, Lopez A, Baldovini A, Fiocchi D, Meresse Z et al. Lung ultrasound findings in the postanesthesia care unit are associated with outcome after major surgery: a prospective observational study in a high-risk cohort. Anesth Analg 2020;132:171-181
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 2008;61:344-349
Cassidy MR, Rosenkranz P, McCabe K, Rosen JE, McAneny D. I COUGH: reducing postoperative pulmonary complications with a multidisciplinary patient care program. JAMA Surg 2013;148:740-745
Duggan M, Kavanagh BP. Pulmonary atelectasis: a pathogenic perioperative entity. Anesthesiology 2005;102:838-854
Lagier D, Zeng C, Fernandez-Bustamante A, Vidal Melo MF. Perioperative pulmonary atelectasis: part II. Clinical implications. Anesthesiology 2022;136:206-236
Leone M, Bouadma L, Bouhemad B, Brissaud O, Dauger S, Gibot S et al. Hospital-acquired pneumonia in ICU. Anaesth Crit Care Pain Med 2018;37:83-98
Slankamenac K, Graf R, Barkun J, Puhan MA, Clavien P-A. The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg 2013;258:1-7
Jammer I, Wickboldt N, Sander M, Smith A, Schultz MJ, Pelosi P et al. Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European perioperative clinical outcome (EPCO) definitions. Eur J Anaesthesiol 2015;32:88-105
Toulouse E, Masseguin C, Lafont B, McGurk G, Harbonn A, A Roberts J et al. French legal approach to clinical research. Anaesth Crit Care Pain Med 2018;37:607-614
Dransart-Rayé O, Roldi E, Zieleskiewicz L, Guinot PG, Mojoli F, Mongodi S et al. Lung ultrasound for early diagnosis of postoperative need for ventilatory support: a prospective observational study. Anaesthesia 2020;75:202-209
Brunelli A, Thomas C, Dinesh P, Lumb A. Enhanced recovery pathway versus standard care in patients undergoing video-assisted thoracoscopic lobectomy. J Thorac Cardiovasc Surg 2017;154:2084-2090
Martin LW, Sarosiek BM, Harrison MA, Hedrick T, Isbell JM, Krupnick AS et al. Implementing a thoracic enhanced recovery program: lessons learned in the first year. Ann Thorac Surg 2018;105:1597-1604
Khandhar SJ, Schatz CL, Collins DT, Graling PR, Rosner CM, Mahajan AK et al. Thoracic enhanced recovery with ambulation after surgery: a 6-year experience. Eur J Cardiothorac Surg 2018;53:1192-1198
KurodaH, SugitaY, Watanabe K, NakanishiK, SakakuraN, NaitoY et al. Successful postoperative recovery management after thoracoscopic lobectomy and segmentectomy using an ERAS-based protocol of immediate ice cream intake and early ambulation: a 3-year study. Cancer Manag Res 2019;11:4201-4207
Daskivich TJ, Houman J, LopezM, Luu M, Fleshner P, Zaghiyan K et al. Association of wearable activity monitors with assessment of daily ambulation and length of stay among patients undergoing major surgery. JAMA Netw Open 2019;2: e187673
Das-Neves-Pereira J-C, Bagan P, Coimbra-Israel A-P, Grimaillof-Junior A, Cesar-Lopez G, Milanez-de-Campos J-R et al. Fast-track rehabilitation for lung cancer lobectomy: a five-year experience. Eur J Cardiothorac Surg 2009;36:383-392
