Can Breathing Exercises Reduce the Risk of Postoperative Infections & Antibiotic Use Following Abdominal Surgery?

At a time when limiting the use of antibiotics as part of an effort to stem the troubling tide of resistance is top of mind, to say the least, the results of a new study suggest possible solutions to the vexing problem of postoperative infections (and other complications)—and, good news: they don’t involve pharmacotherapy.

In an article published on January 24 in BMJ, researchers from a number of academic hospitals in Australia and New Zealand chronicle their findings from an analysis designed to assess the efficacy of a preoperative single intervention—that of a physiotherapy session during which patients are taught breathing exercises—in reducing postoperative pulmonary complications, such as pneumonia, following elective upper abdominal surgery. In a cohort of 432 adult patients followed over the course of a 1-year period, 218 of whom received the intervention (the remainder, who did not, served as controls) incidence of pulmonary complications was reduced by approximately 50%.

“Needless to say, it is fair to hypothesize that by halving postoperative pneumonia incidence rates you would consequently reduce antibiotic prescription,” study co-author Ianthe Boden, APAM, MSc, BAppSc, manager abdominal surgery research group, clinical lead—cardiorespiratory physiotherapy, Tasmanian Health Services, Launceston General Hospital in Australia, told Contagion^®. “Let’s prevent the infection in the first place, rather than waiting for it to happen and then treat it with antibiotics afterwards. Prevention is better than cure. Considering the millions of major abdominal surgical procedures performed in developed countries each year, broad-scale implementation of this simple preoperative physiotherapy intervention will reduce respiratory complications by half and thus should considerably reduce antibiotic usage worldwide.”

Historically, postoperative pulmonary complications have been the most common serious adverse event following upper abdominal surgery, with incidence rates ranging from 10% to 50%, according to the authors of the BMJ paper. Typically, they write, these complications (including pneumonia) are “caused by postoperative pathophysiological reductions in lung volumes, respiratory muscle function, mucociliary clearance, and pain inhibition of respiratory muscles”—hence the intervention selected for analysis.

The patients in the study underwent a variety of procedures, including colorectal, hepatobiliary (upper gastrointestinal (GI)), and renal/vascular surgeries, and there was a fairly even split between laparoscopic and non-laparoscopic approaches. The patients in the intervention group, prior to surgery, met with a physiotherapist, who gave them a booklet on postoperative pulmonary complications and possible prevention approaches, including “early ambulation and breathing exercises.” The intervention patients were prescribed breathing exercises consisting of 2 sets of 10 slow deep breaths followed by 3 coughs, to be performed hourly, starting immediately after surgery.

In these patients, the authors found that the incidence of all pulmonary complications, including pneumonia, within 14 post-operative hospital days was reduced by 48% (P = .001) when compared with the control group. There was an “absolute risk reduction” of 15% for all postoperative pulmonary complications. Overall, 85 of the 432 participants developed a pulmonary complication following surgery; and, intention-to-treat unadjusted results demonstrated that there were fewer among the patients in the physiotherapy group (27/218, 12%) compared with control group (58/214, 27%; P<.001).

“We tested just a single intervention,” said Boden. “There are other interventions physiotherapists could also provide at preoperative clinics that could reduce the risk of respiratory complications further, [such as] inspiratory muscle training, and improve postoperative physical recovery, [such as] pre-habilitation, walking programs, strengthening exercises. Physiotherapists need to become a strong part of the surgical team—as a profession, our interventions can strongly enhance recovery after surgery and prevent complications. Physiotherapists, surgeons, anesthesiologists, and physicians should partner together to focus on patient outcomes.”

Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous health care-related publications. He is the former editor of Infectious Disease Special Edition.