A single 30minute educational session with a physio about post-op breathing exercises prior to elective upper abdo surgery, halves that patient’s risk of respiratory complications compared with usual care, Australian research shows. The randomised study conducted among 441 patients across three hospitals in Australia and New Zealand showed the pre-op intervention reduced the risk of post-operative pulmonary complications from 27% in the control group to 12% in the physio-taught group. In fact, the number need to treat to prevent one such complication was only seven. The effect was greatest in men, those undergoing colorectal surgery, those aged under 65 and those educated by an experienced physiotherapist. So what did this all-important physio session involve? Well, as they say in the classics – it wasn’t rocket science. The physiotherapists had a standard script which included educating the patient about the high likelihood of a pulmonary complication following this type of surgery (10 to 50% according to the literature) and the importance of early ambulation as well as breathing exercises in preventing these. Many patients are unlikely to up and about in the first couple of days following major upper abdominal surgery but at least the breathing exercises can be done from the moment the patient regains consciousness – two sets of 10 slow, deep breaths followed by three coughs, using an abdominal support pillow to reduce pain. And this is to be repeated hourly. This was emphasised in the education session which was conducted at some stage in the six weeks prior to surgery. The physio session also included a practice run through of these exercises. However, interestingly the control group also received pre-op written information about these same facts and exercises, and were reminded of them post-op as part of standard care. What then made the difference? “One explanation for the effectiveness of pre-operative physiotherapy to reduce [post-operative pulmonary complications] is that the preparation, motivation and training of the patient before surgery brings the timing of breathing exercise initiation to immediately after regaining consciousness after surgery,” the study authors suggested. A degree of atelectasis is common with this type of surgery and general anaesthetic. The immediate commencement of these exercises could facilitate the re-inflation of the lungs, and prevent the progression of this atelectasis. The primary end point of this study was the development of one or more of seven respiratory symptoms or signs in the 14 days post op including chest xray evidence of consolidation or collapse, cough with coloured sputum or a respiratory-related high white cell count. One of the secondary endpoints was pneumonia, the relative risk of which was reduced by 52% courtesy of the intervention. In essence, the study showed how the right education and motivation given at the right time can dramatically improve health outcomes with results that are directly applicable to tens of millions of patients awaiting surgery such as this worldwide. “[P]atients reported that pre-operative physiotherapy empowered them to treat themselves and placed high value on its role in improving their post-operative recovery,” the researchers said. Ref: BMJ 2018;360:j5916 doi:10.1136/bmj.j5916