Predictors of prolonged hospital stay in patients undergoing lung resection.

PURPOSE: To identify potential predictors of prolonged length of hospital stay in patients submitted to lung resection surgery. MATERIALS AND METHODS: This is a cohort study, carried out in 105 patients with lung cancer, submitted to posterolateral thoracotomy pulmonary resection. Data collection included preoperative assessment of demographic, clinical, pulmonary function, respiratory muscle function, physical fitness, and behavioral habits. After surgery, length of hospital stay was documented, and the sample was divided into two groups according to the length of hospital stay (LOS): the normal hospital stay group (NLOS) until 8 days, and the prolonged hospital stay group (PLOS) with more than 8 days of hospital stay. Multiple linear regressions were performed between length of hospital stay and the studied variables, for the total sample and, specifically, for the PLOS group. RESULTS: The multiple linear regression for the total sample, the most explanatory power variables were TLC, MIP, PEF, and BMI. When considering only the PLOS, the variables that mostly explained were the MIP%, MEP and TLC%. CONCLUSION: Besides the classic outcomes used to calculate surgical risk, the body mass index, respiratory muscle strength, peak expiratory flow, and total lung capacity are predictors of the variation on length of hospital stay in patients submitted to lung resection.

The addition of the respiratory muscles function in the preoperative assessment, might contribute to predict prolonged hospital stay in patients submitted to lung resection surgery.Respiratory muscle strength might be included in a prehabilitation program for patients selected to lung resection surgery.The preoperative respiratory muscle strength increment might contribute to reduce economic cost related to prolonged hospital stay after pulmonary resection surgery.

Influence of Respiratory Muscle Training on Patients' Recovery after Lung Resection.

This prospective experimental study aimed to compare effects of 3 different home-based postoperative respiratory muscle training protocols - inspiratory, expiratory and combined, in the patients' postoperative recovery, regarding safety and respiratory muscle function, pulmonary function, physical fitness, physical activity (PA), dyspnoea and quality of life (QoL). Patients were divided in four groups Usual Care (UCare), inspiratory (IMT), expiratory (EMT) or combined muscle training (CombT) according to group allocation. Significant treatment*time interactions were found for maximal inspiratory pressure (MIP) (p=0.014), sedentary PA (SEDPA) (p=0.003), light PA (LIGPA) (p=0.045) and total PA (p=0.035). Improvements were observed for MIP in CombT (p=0.001), IMT (p=0.001), EMT (p=0.050). SEDPA reduced in EMT (p=0.001) and IMT (p=0.006), while LIGPA increased in both groups (p=0.001), as well as Total PA (p=0.005 and p=0.001, respectively). In UCare, CombT, and EMT, QoL improved only for Usual Activities. In conclusion, the addition of respiratory muscle training to physiotherapy usual care is safe and effective to increase MIP and contribute to improve physical activity. The CombT showed greater improvement on MIP, while IMT compared to EMT, was more effective to improve physical activity.

Inspiratory muscle training is effective to reduce postoperative pulmonary complications and length of hospital stay: a systematic review and meta-analysis.

PURPOSE: This study systematically review and meta-analyse the effectiveness of inspiratory muscle training (IMT) to reduce postoperative pulmonary complications (PPC) and length of hospital stay (LOS), both in the preoperative and/or postoperative periods of cardiac, pulmonary, and abdominal surgical patients. Sensitive analysis was performed to examine which patients benefit more from IMT according to methodological features (quality of studies and sample size), patient's characteristics (pulmonary risk stratification, age, and body mass index), type of surgery, period of training, and training protocols (training doses and level of supervision). METHODS: The literature search was made in the electronic databases PubMed®, EBSCO, Web of Science®, PEDro and Scopus®. Only randomized controlled trials were included. Data extraction, quality assessment and meta-analysis were performed. RESULTS: We included 17 randomized controlled trials in the systematic review, of which, 12 were included for the PPC meta-analysis and 11 for the LOS meta-analysis. IMT significantly reduced the risk of PPC (Risk Ratio (RR) = 0.50, 95%CI: 0.39, 0.64, I2 = 0.0%), and a decrease in LOS (Mean Difference = -1.41, 95%CI: -2.07, -0.75, I2 = 0.0%). CONCLUSION: IMT is effective to reduce PPC and LOS in patients undergoing surgery. Implications for Rehabilitation Physiotherapy interventions with inspiratory muscle training (IMT) are effective to reduce postoperative pulmonary complications (PPC) and length of hospital stay (LOS) after major surgery, and should start preoperatively. Rehabilitation with IMT is beneficial at all ages and risk levels, but older and high-risk patients benefit more, as well as pulmonary surgery patients. IMT is more effective if it is supervised, and prescription target at least two-week period, sessions with more than 15 minutes, with imposed load increment, and adding other exercise modes.

Tetralogy of Fallot: prognostic factors after surgical repair.

INTRODUCTION AND OBJECTIVE: Corrective surgery for tetralogy of Fallot (TF) has led to excellent survival. However; several years after surgery, the majority of patients have right ventricular (RV) dilatation, and 10% will need reoperation of the RV outflow tract due to limited exercise capacity, ventricular arrhythmias or symptoms of heart failure (HF). Our aim was to identify predictive factors of adverse outcome: moderate to severe RV dilatation, HF, reoperation of the RV outflow tract and cardiac death. METHODS: Eighty-eight adult patients with TF were operated between January 1977 and July 2001; 22 were lost to follow-up and 66 were followed for 18 +/- 6 years. We analyzed clinical, electrocardiographic and echocardiographic variables. RV dilatation was considered to exist if the inlet measurement at end-diastole in 4-chamber apical view was more than 35 mm, being classified as moderate when > or = 50 and < 60 mm and severe when > or = 60 mm. RESULTS: Of the 66 patients, 25 (37.9%) had undergone previous palliative shunt (PS) at the age of 4 +/- 5 years. Mean age at surgical correction was 10 +/- 8 years (range: < 1 to 38 years; median: 6.5 years). Transannular patching was used in 65% of patients, patch closure of a right ventriculotomy in 91%, and in 53% of patients a pulmonary commissurotomy was performed. At the end of follow-up, 3 patients were in NYHA class III-IV and one patient was successfully reoperated with implantation of a biological pulmonary valve. Prevalence of RV dilatation was 97% (57/59), being moderate to severe in 69% (36/52). In patients with moderate to severe RV dilatation we found previous PS (18.8 vs. 50.0%; p = 0.03), transannular patching (37.5 vs. 75.0%; p 0.01) and wide QRS (160 ms) (6.7 vs. 45.7%, p = 0.01) to be more frequent. These patients reported more palpitations (0 vs. 22.2%; p 0.05), but there were no differences in arrhythmic events (18.8 vs. 33.3%; p = 0.28); maximal heart rate on exercise was lower (86.2 +/- 10.9 vs. 79.9 +/- 8.6; p = 0.04), but exercise time and functional capacity were similar between the groups. Follow-up time and use of RV patching were similar. Transannular patching was associated with previous PS at an older age (0.9 +/- 0.7 vs. 4.9 +/- 5.7 years; p = 0.01), a higher grade of pulmonary regurgitation (III-IV) (22.7 vs. 57.5%; p = 0.01), wide QRS (160 ms) (9.5 vs. 41.0%, p = 0.01), and greater RV dilatation. No mortality was reported. CONCLUSION: Transannular patching and performance of previous PS were predictive factors of severe RV dilatation, and pulmonary regurgitation seems to be its physiological mechanism. Despite this, long-term prognosis is favorable and patients have good functional capacity.