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. 2022 May 2;6(3):zrac063.
doi: 10.1093/bjsopen/zrac063.

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

Bruno Pastene  1   2 , Ambroise Labarriere  1 , Alexandre Lopez  1 , Aude Charvet  1 , Aurélien Culver  1 , David Fiocchi  1 , Armand Cluzel  3 , Geoffrey Brioude  3 , Sharon Einav  4 , James Tankel  5 , Zeinab Hamidou  6 , Xavier Benoit D'Journo  3 , Pascal Thomas  3 , Marc Leone  1   2 , Laurent Zieleskiewicz  1   2   7 ; GRACE Association
Collaborators, Affiliations

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

Bruno Pastene et al. BJS Open. .

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.

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Figures

Fig. 1
Fig. 1
Timelines of control (a) and intervention (b) group i.v., intravenous; PACU, post-anaesthesia care unit.
Fig. 2
Fig. 2
Flow chart of patient allocation for the study
See this image and copyright information in PMC

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