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Comparison of recognition tools for postoperative pulmonary complications following thoracotomy

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Agostini, P., Naidu, Babu V., Cieslik, H., Rathinam, S., Bishay, E., Kalkat, M. S., Rajesh, Pala Babu, Steyn, R. S. and Singh, S.. (2011) Comparison of recognition tools for postoperative pulmonary complications following thoracotomy. Physiotherapy, Vol.97 (No.4). pp. 278-283. ISSN 0031-9406

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Official URL: http://dx.doi.org/10.1016/j.physio.2010.11.007

Abstract

Objectives To evaluate the recognition of postoperative pulmonary complications (PPC) following thoracotomy and lung resection using three PPC scoring tools.

Design Prospective observational study.

Setting Regional thoracic centre.

Participants One hundred and twenty-nine consecutive thoracotomy and lung resection patients (October 2007 and April 2008).

Main outcome measures PPC assessment was performed on a daily basis using three sets of criteria described by Brooks-Brunn, Gosselink et al. and Reeve et al.: the Brooks-Brunn Score (BBS), Gosselink Score (GS) and Melbourne Group Scale (MGS), respectively. The results were compared with treatment for PPC and clinical outcomes including mortality, postoperative length of stay and high dependency unit length of stay.

Results PPC frequency was 13% (17/129) with the MGS, 6% (8/129) with the GS and 40% (51/129) with the BBS. The clinically observed incidence of treated (requiring antibiotic therapy or bronchoscopy) PPC was 12% (16/129).

Conclusion PPC treatment following thoracotomy is common. Of the three scoring tools, the MGS outperforms the BBS and the GS in terms of PPC recognition following thoracotomy and lung resection. Patients with a PPC-positive MGS score have a worse outcome as defined by mortality, high dependency unit length of stay and postoperative length of stay. The MGS is an easy-to-use multidisciplinary scoring tool, but further work is required into its use in minimally invasive surgery and in targeting high-risk groups for therapy.

Item Type:	Journal Article
Subjects:	R Medicine > RD Surgery
Divisions:	Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Lungs -- Surgery -- Complications, Postoperative care, Lungs -- Diseases
Journal or Publication Title:	Physiotherapy
Publisher:	Elsevier Science Ltd.
ISSN:	0031-9406
Official Date:	December 2011
Volume:	Vol.97
Number:	No.4
Page Range:	pp. 278-283
Identification Number:	10.1016/j.physio.2010.11.007
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
References:	[1] Garcia – Miguel FJ, Serrano- Aguilar PG, Lopez-Bastida J. Preoperative assessment. The Lancet 2003; 362:1749-1759. [2] Lumb AB. Nunn’s Applied Respiratory Physiology. 6th ed. Oxford: Butterworth Heinemann 2005 [3] Ginsberg RJ. Preoperative Assessment Of The Thoracic Surgical Patient: A Surgeon’s Viewpoint. In Pearson FG, Deslauriers J, Ginsberg RJ, Hiebert C, McKneally MF, Urschel HC (eds) Thoracic Surgery, Churchill Livingstone, Heinemann New York 2009 362:1749-1757 [4] Stéphan F, Boucheseiche S, Hollande J, Flahault A, Cheffi A, Bazelly B, et al. Pulmonary complications following lung resection: a comprehensive analysis of incidence and possible risk factors. Chest 2000 Nov;118 (5):1263-70. [5] Ploeg AJ, Kappetein A P, van Tongeren R B, Pahlplatz P V, Kastelein G W, Breslau P J. Factors associated with perioperative complications and long-term results after pulmonary resection for primary carcinoma of the lung. European Journal of Cardiothoraic Surgery 2003; 23:26-29 [6] Weiner P, Man A, Weiner M, Rabner M, Waizman J, Magadle R et al. The effect of incentive spirometry and inspiratory muscle training on pulmonary function after lung resection. Journal of Thoracic and Cardiovascular Surgery 1997; 113 (3): 552-557 [7] Varela G, Ballesteros E, Jimenez, MF, Novoa N, Aranda JL. Cost-effectiveness analysis of prophylactic respiratory physiotherapy in pulmonary lobectomy. European Journal of Cardio-thoracic Surgery 2006; 29: 216-220 [8] Brooks-Brunn J A. Predictors of Postoperative pulomonary complications following abdominal surgery. Chest 1997; 111 (3): 564-571 [9] Gosselink R, Schrever K, Cops P, Witvrouwen H, De LP, Troosters T, et al. Incentive spirometry does not enhance recovery after thoracic surgery. Critical Care Medicine 2000; 28(3):679-83 [10] Reeve J C, Nicol K, Stiller K, McPherson K M, Denehy L. Does physiotherapy reduce the incidence of postoperative complications in patients following pulmonary resection via thoracotomy? a protocol for a randomised controlled trial. Journal of Cardiothoracic Surgery 2008; 3:48 [11] Reeve J C, Nicol K, Stiller K, McPherson K M, Birch P, Gordon I, et al. Does physiotherapy reduce the incidence of postoperative pulmonary complications following pulmonary resection via open thoracotomy? A preliminary randomised single-blind clinical trial. European Journal of Cardiothoracic Surgery 2010;37:1158-66 [12] Brasher PA, McClelland KH, Denehy L, Story I. Does removal of deep breathing exercises from a physiotherapy program including pre-operative education and early mobilisation after cardiac surgery alter patient outcomes? Australian Journal of Physiotherapy 2003;49:165-73 [13] Denehy L, Carroll S, Ntoumenopoulos G, Jenkins S. A randomized controlled trial comparing periodic mask CPAP with physiotherapy after abdominal surgery. Physiotherapy Research International 2001;6:236-50 [14] Browning L, Denehy L, Scholes R. The quantity of early upright mobilisation performed following upper abdominal surgery is low: an observational study. Australian Journal of Physiotherapy 2007;53:47-52 [15] Agostini P, Cieslik H, Rathinam S, Bishay E, Kalkat M, Rajesh PB, et al. Postoperative Pulmonary Complications following Thoracic Surgery: Are there any Modifiable Risk Factors? Thorax 2010; 65(9):815-8 [16] Gardner-Thorpe J, Love N, Wrightson J, Walsh S, Keeling N. The value of Modified Early Warning Score (MEWS) in surgical in-patients: a prospective observational study. Annals of the Royal College of Surgeons (England) 2006; 88:571-575
URI:	http://wrap.warwick.ac.uk/id/eprint/39843