Implementation of perioperative breathing exercises and its effect on postoperative pulmonary complications and long-term prognosis in elderly patients undergoing laparoscopic colorectal surgery: A randomized controlled trial

Abstract

Objective This study was to investigate the impact of breathing exercises on recovery in elderly patients receiving laparoscopic colorectal surgery. Design A prospective randomized controlled trial. Setting University hospital. Subject A total of 264 elder patients undergoing laparoscopic colorectal surgery participated in this study. Intervention Patients in intervention group received respiratory-related exercises based on standardized enhanced recovery after surgery strategies from admission to 90 days after surgery. The control group received perioperative standardized enhanced recovery after surgery strategies without formatted breathing exercises. Main measures The primary outcome was the incidence of postoperative pulmonary complications. The secondary outcomes included 6-minute walking distance, surgery-related complications, length of stay, mortality postoperatively, and hospitalization costs. Results Completion rate of breathing exercise in intervention group was over 80% till 90 days postoperatively. The incidence of postoperative pulmonary complications was lower in breathing exercises group (17/132 [12.9%] vs. 43/132 [32.6%], p < 0.001). The mean value of 6-minute walking distance increased more in intervention group compared with baseline values preoperatively (44.2 ± 4.3 vs. 3.2 ± 0.2, p < 0.001). On 90 days postoperatively, the mean value of 6-minute walking distance in breathing exercises group increased by 18.8 m compared with its baseline (557.0 ± 133.5 vs. 538.2 ± 112.7, p = 0.022), while that of control group decreased by 53.2 m from baseline (481.9 ± 102.5 vs. 535.1 ± 123.4, p < 0.001). Patients who received breathing exercises had shorter length of stay and lower hospitalization costs ( p < 0.050). Conclusions Perioperative breathing exercises helped prevent postoperative pulmonary complications and improve long-term prognosis in elderly patients undergoing laparoscopic colorectal surgery.

O impacto de programas de reabilitação da marcha no tempo de internamento hospitalar – Scoping Review

“…As publicações ocorreram entre 2017 e 2022, com cerca de 42% dos artigos produzidos no ano 2020, em plena pandemia. Um quarto dos artigos, provêm da América do Norte (16)(17)(18)(19)(20)(21)(22)(23)(24) embora se encontre produção científica de países europeus (25)(26)(27)(28)(29) asiáticos (30)(31)(32)(33)(34) da américa do sul (35)(36)(37)(38) e da oceânia (39) . Relativamente à tipologia, 18 dos 24 estudos, constituíram ensaios clínicos randomizados (16-21, 26-33, 36, 38-40) dois são revisões de literatura (23,37) e quatro estudos observacionais (22,24,34,35) .…”

“…Figura 1 -Diagrama PRISMA Os artigos foram analisados e agrupados nos diferentes contextos, de acordo com as necessidades de cuidados e com as patologias de 9 540 participantes que conduziram ao internamento hospitalar. Foram encontrados programas de marcha em pessoas sujeitas a cirurgia colorretal (16,18,30) , ginecológica (19,26) , urológica (21) , cardiotorácica (31,37,38) , da anca (32,33,36) e de coluna (23) . Em doentes não cirúrgicos, em internamento de medicina (17,25,27) e de neurologia (22,29) , foram também identificados resultados desta intervenção.…”

“…Apesar da variabilidade dos programas, todos abordam as questões da marcha, tendo sido agrupados em três categorias, programas de intervenção multimodal (18,19,22,23,26,30,31,34,35) , como o protocolo ERAS, que se caracterizam por uma abordagem integrada envolvendo diferentes profissionais de saúde numa perspetiva de otimização perioperatória, controlando aspetos como a dor, o risco de tromboembolismo, o tempo de jejum, a função gastrointestinal e a mobilização precoce; programas de exercícios (24,25,28,29,32,(36)(37)(38)(39) que além da marcha, incluem atividades de treino de equilíbrio, força muscular, resistência, entre outros; e programas exclusivos de marcha, nomeadamente marcha assistida (16,17,27) , marcha suspensa (20) caminhada por objetivos (33) e sob incentivo financeiro (21) .…”

“…Na maioria dos estudos o tempo de internamento é semelhante entre os grupos de intervenção e os grupos de controlo (16-18, 21, 25, 27-29, 32, 33, 38, 39) , todavia um terço dos artigos analisados concluem que os programas de marcha diminuem o tempo de internamento global entre 1 e 3 dias (19,23,24,26,30,31,36,37) . Apenas dois evidenciaram um aumento no tempo de hospitalização (20,35) , estando associado a pessoas com estados de saúde mais agravados.…”

The Effects of Breathing Exercises on Patients Having Laparoscopic Cholecystectomy Surgery

“…In Hussein and Taha’s (2018) study, which examined the effect of postoperative respiratory exercise on the recovery quality of patients, the recovery quality of the patients in the experimental group was significantly better. Similarly, perioperative breathing exercises were found to help improve the long-term prognosis postoperatively in elderly patients undergoing laparoscopic colorectal surgery (Chen et al, 2022). Conversely, no significant difference in the quality of recovery between the experimental and control groups was found in Westerdahl et al’s (2014) study.…”