Association of postoperative pulmonary complications with delayed mobilisation following major abdominal surgery: an observational cohort study
Association of postoperative pulmonary complications with delayed mobilisation following major abdominal surgery: an observational cohort study
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DOI：
10.1016/j.physio.2012.05.013
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发表时间：
2013-06-01
期刊：
影响因子：
3.3
通讯作者：
Berney, S.
中科院分区：
文献类型：
--
作者：
Haines, K. J.;Skinner, E. H.;Berney, S.
澳大利亚先前的研究报告称，13%的上腹部剖腹手术患者发生术后肺部并发症。本研究测量了一组高危腹部手术患者术后肺部并发症的发生率、术后肺部并发症诊断的危险因素和物理治疗动员的障碍。前瞻性、观察性队列研究。澳大利亚一家三级医院的两个外科病房。72例接受高危腹部手术的患者（一项评估新型医疗联合管理模式的大型试验的参与者）。主要结局指标术后肺部并发症的发生率、危险因素、活动障碍和住院时间。结果术后肺部并发症发生率为39%。切口类型和离开床的时间与术后肺部并发症的诊断独立相关。术后未离开床的每一天，患者发生术后肺部并发症的可能性增加3.0倍（95%可信区间1.2 - 8.0）。52%的患者在术后第一天有活动障碍，最常见的障碍是低血压，尽管物理治疗师没有客观地定义停止标准。术后肺部并发症的发生增加了中位住院时间（16天vs 13天；P = 0.046）。结论：本研究证实了延迟术后活动与术后肺部并发症之间的关联。需要随机对照试验来检验早期活动在预防高危上腹部手术患者术后肺部并发症中的作用。(c) 2012年特许物理治疗学会。Elsevier Ltd.出版。版权所有。
Objectives Previous Australian studies reported that postoperative pulmonary complications affect 13% of patients undergoing upper abdominal laparotomy. This study measured the incidence of postoperative pulmonary complications, risk factors for the diagnosis of postoperative pulmonary complications and barriers to physiotherapy mobilisation in a cohort of patients undergoing high-risk abdominal surgery.Design Prospective, observational cohort study.Setting Two surgical wards in a tertiary Australian hospital.Participants Seventy-two patients undergoing high-risk abdominal surgery (participants in a larger trial evaluating a novel model of medical co-management).Main outcome measures Incidence of, and risk factors for, postoperative pulmonary complications, barriers to mobilisation and length of stay.Results The incidence of postoperative pulmonary complications was 39%. Incision type and time to mobilise away from the bed were independently associated with a diagnosis of postoperative pulmonary complications. Patients were 3.0(95% confidence interval 1.2 to 8.0) times more likely to develop a postoperative pulmonary complication for each postoperative day they did not mobilise away from the bed. Fifty-two percent of patients had a barrier to mobilisation away from the bed on the first postoperative day, with the most common barrier being hypotension, although cessation criteria were not defined objectively by physiotherapists. Development of a postoperative pulmonary complication increased median hospital length of stay (16 vs 13 days; P = 0.046).Conclusions This study demonstrated an association between delayed postoperative mobilisation and postoperative pulmonary complications. Randomised controlled trials are required to test the role of early mobilisation in preventing postoperative pulmonary complications in patients undergoing high-risk upper abdominal surgery. (c) 2012 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.