Incidence of postoperative pulmonary complications (PPC) in patients undergoing thoracic and abdominal surgery remains high and the occurrence of these complications has enormous implications for the patient and the health care system. Complications may be related to anesthesia, mechanical ventilation, tissue damage, immobilization and pain. These conditions cause decreased lung volumes and limited airway clearance, which can lead to PPC such as atelectasis, pneumonia and hypoxemia. Health professionals involved in the management of patient undergoing surgery needs to be aware that postoperative pulmonary complications are a major cause of morbidity, mortality, prolonged hospital stay, and increased cost of care.

The incidence of PPC varies in relation to type of surgery. After thoracoabdominal surgery like esophagectomy or thoraco-abdominal aorta aneurism repair, incidences between 15 and 32% have been reported. Within open lung, cardiac or abdominal surgery, PPC is less frequent with an incidence between 1 and 20%. In recent years, less invasive surgical techniques such as laparoscopy have become more widespread. Furthermore, anesthesiology and postoperative treatments involving analgesics and mobilization have been optimized. This makes it possible for older and fragile patients with co-morbidities to be offered surgery. Thus, prevention of PPC is therefore highly relevant. Prophylactic physiotherapy, especially in the postoperative period, has traditionally been a part of the standard treatment after thoracic and abdominal surgery. Evidence is scarce on the effect of preventive measures of PPC such as respiratory physiotherapy techniques like incentive spirometry, continuous positive airway pressure (CPAP) and positive expiratory pressure (PEP) in this patient group of surgery patients.

Moreover, evidence for early mobilization protocols is inconsistent. However, a few studies have found that high risk patients in particular benefit from specific respiratory physiotherapy techniques to reduce their risk of PPC. Therefore, a precise and systematic preoperative assessment of patients´ risk of PPC could facilitate an early and optimized intervention to prevent development and progression of PPC. For instance, the time point for initiation of respiratory physiotherapy techniques in the early postoperative period could be accentuated in high risk patients.

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Regards
ALEX JOHN
Managing Editor
General Surgery: Open Access