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Ultra-early initiation of postoperative rehabilitation in the post-anaesthesia care unit after major thoracic surgery: case–control study

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 reha...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9127337/
https://www.ncbi.nlm.nih.gov/pubmed/35607804
http://dx.doi.org/10.1093/bjsopen/zrac063
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author 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
author_facet 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
author_sort Pastene, Bruno
collection PubMed
description 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.
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spelling pubmed-91273372022-05-24 Ultra-early initiation of postoperative rehabilitation in the post-anaesthesia care unit after major thoracic surgery: case–control study 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 BJS Open Original Article 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. Oxford University Press 2022-05-24 /pmc/articles/PMC9127337/ /pubmed/35607804 http://dx.doi.org/10.1093/bjsopen/zrac063 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Original Article
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
Ultra-early initiation of postoperative rehabilitation in the post-anaesthesia care unit after major thoracic surgery: case–control study
title Ultra-early initiation of postoperative rehabilitation in the post-anaesthesia care unit after major thoracic surgery: case–control study
title_full Ultra-early initiation of postoperative rehabilitation in the post-anaesthesia care unit after major thoracic surgery: case–control study
title_fullStr Ultra-early initiation of postoperative rehabilitation in the post-anaesthesia care unit after major thoracic surgery: case–control study
title_full_unstemmed Ultra-early initiation of postoperative rehabilitation in the post-anaesthesia care unit after major thoracic surgery: case–control study
title_short Ultra-early initiation of postoperative rehabilitation in the post-anaesthesia care unit after major thoracic surgery: case–control study
title_sort ultra-early initiation of postoperative rehabilitation in the post-anaesthesia care unit after major thoracic surgery: case–control study
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9127337/
https://www.ncbi.nlm.nih.gov/pubmed/35607804
http://dx.doi.org/10.1093/bjsopen/zrac063
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