Respiratory Rehabilitation in Patients with Abdominal Aortic Aneurysm Submitted to OPEN and EVAR Treatment: Predictive Factors of Postoperative Pulmonary Complications and Clinical Implications

Abstract

Background: In the conventional surgical treatment of aneurysms, the respiratory physiotherapy is one of the cornerstones of patient rehabilitation. The endovascular technique, with less invasiveness, has significantly changed the rehabilitative approach to the operated subject.Objective of the study: to evaluate and compare the effectiveness of the pre and post-operative rehabilitation treatment associated with the conventional OPEN surgery compared to the EVAR procedure and their incidence in preventing postoperative respiratory complications.Design: Longitudinal case control study to compare patients who have open surgery with patients who do not have the laparotomy, as in ENDO technique, to look how frequently the postoperative pneumonia and the risk factor was present in each group to determine the relationship between the risk factor, the type of operation and the pneumonia incidence.Setting Data were collected from patients admitted consecutively at the Tor Vergata Hospital with diagnosis of an abdominal aortic aneurysm. Risk factors, type of intervention, pneumonia incidence in postoperative period was evaluted at 30 days.Population: Three hundred and twenty patient were enrolled. Materials and methods:From 2005 to 2016, 320 patients suffering from an abdominal aortic aneurysm were treated consecutively. One hundred eighty one patients were treated using the open technique (group A) and 139 using the EVAR technique (group B). All patients in OPEN group were submitted to respiratory rehabilitation protocol. Risk factors, type of intervention, anesthesia and results of treatment with complications, observed mortality, mean hospital stay were studied. Pre and postoperative respiratory rehabilitation treatment protocol was performed in all of the patients. The data were analyzed with descriptive statistics and inferential statistics using SPSS 18.0 for Windows.Results: From 2005-2010, the postoperative stay (days) was significant shorter for EVAR compared to open (6.47 vs. 10.48; P 0.001). From 2011-2016, the postoperative stay (days) was significant shorter EVAR compared open (4.07 vs. 11.41; P 0.001). The patients treated from 2011 to 2016 for both OPEN and EVAR groups presented an average age 3 years lower compared to the patients treated in the period from 2005-2011 (75.5 to 72.8 for EVAR and from 71,2 to 68,2). The patients treated from 2011 to 2016 for EVAR group presented an average reduction in post-operative hospitalization of 2.4 days (-37.09%) compared to 2005-2011 period. There was a significant higher incidence of pneumonia in the open group (P=0.001). The reduction of the incidence of pneumonia in group A and B during the two different periods from 2005 to 2010 and from 2011 to 2016 was observed. There wasn't a significant difference in the incidence of pneumonia in patients treated from 2005 to 2010

Avaliação da influência da anatomia dos aneurismas de aorta abdominal infra-renal nos eventos intra-operatórios e nos desfechos clínicos no pós-operatório na Unidade de Terapia Intensiva após cirurgia endovascular

“…Na literatura, o tempo médio de cirurgia variou entre 89 a 158 minutos 61,79,82,100,111 . A perda sanguínea média na literatura variou de 200 a 498ml 61,82,112,113 .…”

“…A taxa de transfusão sanguínea perioperatória após cirurgia vascular varia entre 11 a 29% 82,[113][114][115][116][117] , com uma média de transfusão de 3 concentrados de hemácias (103). A literatura mostra que a transfusão sanguínea perioperatória aumenta o tempo de internação na terapia intensiva e hospitalar, na morbidade 79,118,119 e na taxa de mortalidade [114][115][116] .…”

“…Atualmente, existem diversos serviços, em sua maioria estrangeiros, que não fazem obrigatoriamente pós-operatório de REVAAA em ambiente de terapia intensiva. Existe, para isso, seleção criteriosa dos doentes, baseada em protocolos preestabelecidos, com menores chances de complicação 113,117,121,123,124,126 .…”

“…No pós-operatório de REVAAA, as taxas de pneumonia variam entre 0,8 e 2,8% 62,56,113,117,121,123,127 , de IAM, entre 0,3 e 2,9% 79,56,117,121,123 ), de AVC variam entre 0,2 e 0,5% 117,121,123 . As taxas de IRA variam entre 0,6 a 18% 56,121,123,128,129 .…”

“…Pneumonia está entre as infecções mais comuns no pós-operatório de REVAAA. A ocorrência de maiores taxas de pneumonia está associada à presença de patologias pulmonares prévias, maior tempo de intubação no pós-operatório e anestesia geral, e levam a maior tempo de internação hospitalar e maiores taxas de readmissão hospitalar 56,113,117,123,124,128 .…”