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Enhancing early post-operative physiotherapy input to patients undergoing an oesophagectomy: A quality improvement project

Angharad Volk, Rhian Kennedy-Warbuton, Paul Twose

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Introduction

Postoperative pulmonary complications are a serious morbidity following an oesophagectomy with rates as high as 45%. In 2017, a local physiotherapy review identified a high number of patients being diagnosed with significant complications such as post-operative pulmonary complications which increased length of stay, requirement for critical care admissions and need for respiratory physiotherapy. As a result, strategies to reduce PPC rates were proposed. This quality improvement project explored the impact of increasing physiotherapy input during the first three days post oesophagectomy on the incidence of PPCs.

Methods

A Plan-Do-Study-Act approach was adopted. Following the increase of physiotherapy input to twice daily during the first 3 post-operative days, data was collected over a 6-month period. This data was then compared to previously collected data pre-quality improvement intervention. The primary outcome was post-operative pulmonary complications occurrence, and secondary measures were mobility markers and hospital length of stay.

Results

Comparison of pre and during quality improvement data demonstrated that despite increased physiotherapy input there was no reduction on the incidence of post-operative pulmonary complications or secondary outcomes.

Conclusion

Enhancing physiotherapy input in the first 3 post-operative days had no effect on reducing the incidence of post-operative pulmonary complications. Similarly, there was no change in the achievement of mobility markers or hospital length of stay.  Further research is now required to explore other interventions such as pre-habilitation, including inspiratory muscle training, and their impact on post-operative pulmonary complications occurrence.



2020 Journal (Vol. 52)
Journal of the Association of Chartered Physiotherapists in Respiratory Care. Volume 52. Issue 1. 2020. Article on: p 27-37
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