Ms Ianthe Boden1,2, Dr Elizabeth Skinner2,3, Dr Laura Browning2,3, Professor David Story4, Professor Linda Denehy2
1Launceston General Hospital, Launceston, Australia, 2University of Melbourne, Melbourne, Australia, 3Division of Allied Health, Western Health, Footscray, Australia, 4Department of Aneasthesia, University of Melbourne, Melbourne, Australia
Introduction: A postoperative pulmonary complication (PPC) is the most common serious complication following upper abdominal surgery. Preparing patients preoperatively so that breathing exercises are initiated immediately upon awakening may prevent PPCs.
Methods: LIPPSMAck POP was a pragmatic, bi-national, multi-centre, double blinded, parallel group, randomised controlled superiority trial. 441 adults scheduled for elective open upper abdominal surgery at three Australian and New Zealand hospitals were randomised using concealed allocation to receive either i) an information booklet or ii) an information booklet and a single preoperative physiotherapy education and training session. Postoperative early mobilisation was standardised and no additional respiratory physiotherapy was provided. Primary outcome was PPC using standardised diagnostic criteria. Secondary outcomes include hospital length of stay (LOS), pneumonia, ICU readmission, 30 day patient reported complications, and all-cause mortality to 12 months. Data was adjusted for covariates and analysed intention-to-treat and per-protocol.
Results: 434 participants completed the trial (98%). Preoperative physiotherapy halved PPC (HR 0.48, 95%CI 0.31 to 0.76: p<.001) and pneumonia (HR 0.48, 95%CI 0.27 to 0.84) with a NNT of 6 (95%CI 4 to 11). Patients in the intervention group were ready for discharge a day earlier (8.6 v 7.5 days, p=.02) and, if seen by an experienced physiotherapist prior to surgery, there was a stronger prophylactic effect size and patients were consequently more likely to be alive at 3 and 12 months (HR 0.31, 95%CI 0.11 to 0.88, p=.03). Per-protocol analysis strengthened the effect across all outcomes including lower LOS; 3 days (13.7 v 10.6 days, p=.03) and less 6-week respiratory complications (IRR 0.62, 95%CI 0.38 to 1.0, p=.05). Conclusion: LIPPSMAck POP is the most rigorous trial investigating physiotherapy to prevent PPC following surgery to date providing conclusive evidence that a single preoperative physiotherapy education session prevents PPC and mortality following major upper abdominal surgery.
Ianthe Boden is the Cardiorespiratory Team Leader at the Launceston General Hospital. Ianthe is currently completing a PhD at The University of Melbourne investigating the prevention of pulmonary complications following abdominal surgery. Ianthe’s first randomised controlled trial, LIPPSMACK-POP, has won major research prizes at Physiotherapy, Anaesthetics, and Surgery conferences. Ianthe is currently Chief Investigator of two active randomised controlled trials (ICEAGE and NIPPER PLUS) and leading CHESTY (Chest infection prevalence after surgery). CHESTY will be one of the largest international collaborative trials in Cardiorespiratory Physiotherapy and will involve over 40 hospitals world-wide.