Risk factors classification and perioperative pulmonary rehabilitation in surgery: A prospective study

Introduction. Chest Physical Therapy (CPT) is widely used for prevention of pulmonary postoperative infectious complications. Recent reviews of the literature confirm the advantages of CPT in preventing postoperative pneumonia, at least in selected patients. Time and professional human resources spent in providing CPT should, therefore, be considered worthwhile. Easy instruments should be identified to perioperatively classify patients in surgical and rehabilitation departments to optimize treatment and organization. Aims. To test a scale for the identification of risk for pulmonary infectious complications in surgical patients and to evaluate the usefulness of scale, to postoperatively evaluate the pertinence of chest rehabilitation related to risk classes and to infectious complications. Methods. 100 in-patients scheduled for surgery were enrolled. All patients were classified at low, medium and high risk for pulmonary complications through a scale. Patients were then treated with CPT before and after surgery. The patients were postoperatively monitored and the different rehabilitation options were recorded, as well as the incidence of pulmonary complications. Results. Statistical analysis showed a significative difference in the incidence of complications between high and medium risk classes (p = 0.0198); no complication was registered in low-risk patients. The number of rehabilitation treatments shows homogeneity assignment between the three classes. Only for one rehabilitation treatment there has been a remarkable difference among classes in relation to the number of chest rehabilitation sessions performed (p = 0.001). Conclusions. The scale used to classify risk of pulmonary complications demonstrated useful in discriminating surgical patients in the three classes. Greater pulmonary complications have been recorded in high risk patients. The different incidence of pulmonary infectious complications among the three classes of risk confirms the need of better re-distribution of rehabilitation resources dedicated to high risk patients.