Preoperative physical therapy for elective cardiac surgery patients

Patients undergoing cardiac surgery are at risk of postoperative pulmonary complications such as pneumonia. These complications prolong postoperative recovery and may even lead to death. Increased physical fitness improves people’s functional capacity, including their lungs, and could result in individuals being better prepared to withstand the consequences of the physical stress of surgery.

The authors of this recent Cochrane review evaluated the efficacy and safety of preoperative physical therapy with an exercise component in cardiac surgery patients. From the pertinent literature, eight studies met the inclusion criteria, comprising a total of 856 participants. The results showed that preoperative physical therapy reduced the number of patients who experienced atelectasis or pneumonia but not the number of patients who experienced pneumothorax, prolonged ventilation or postoperative death. Patients who had preoperative physical therapy had an earlier (on average by more than three days) discharge from the hospital. Information on adverse events was limited but those studies that did report on adverse events reported none. None of the studies reported on the costs of preoperative physical therapy.

Evidence derived from small trials suggests that preoperative physical therapy reduces postoperative pulmonary complications (atelectasis and pneumonia) and length of hospital stay in patients undergoing elective cardiac surgery. There is a lack of evidence that preoperative physical therapy reduces postoperative pneumothorax, prolonged mechanical ventilation or all-cause deaths.

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