To assess the effectiveness of preoperative intervention program in reducing the incidence of postoperative pulmonary complications (PPCs) and 30-day mortality rate after thoracic surgery in high-risk patients.
A 3-week preoperative intervention program, consisting of chest physiotherapy, exercise training, smoking cessation and psychological counseling, was offered to high-risk patients with preoperative FEV1<80% predicted or current smokers in a tertiary respiratory medical centre before undergoing thoracic surgery. The 30-day mortality rate and incidence of PPCs, which are defined as pneumonia, atelectasis, PaCO2 greater than 50mmHg lasting for more than 48 hours after surgery, and respiratory failure requiring mechanical ventilation, was compared to those of a group of patients who did not participate in the program (control group).
Between April 1, 2000 and March 31, 2002, 42 patients in the intervention group and 27 controls were studied. The baseline characteristics between the 2 groups were comparable except age and the percentage of malignancy. 62% of patients in the intervention group completed the 3-week training. In the intervention group, the mean 6-minute walk distance improved by 38.6 metre (p<0.05) after training. There was no difference in the rates of PPCs and postoperative ICU admission & the hospital stay between the intervention and control groups. The 30-day mortality rate, however, was lower in the intervention group and the difference approached statistical significance.
Preoperative intervention program improves the mean 6-minute walk distance with statistical significance. It also reduces the 30-day mortality rate. Randomized controlled trial is warranted for better assessment of its efficacy.
Pulmonary complications are common contributors to mortality and morbidity after thoracic surgery. The risk is increased in smokers and those with preexisting lung diseases. Preoperative intervention program may help to improve the postoperative outcome in this group of patients.
Wai Ming Yung, None.