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Preoperative physiotherapy education prevented postoperative pulmonary complications following open upper abdominal surgery
  1. Shane Patman
  1. School of Physiotherapy, University of Notre Dame Australia, Fremantle, Western Australia, Australia
  1. Correspondence to Assoc Prof Shane Patman, School of Physiotherapy, University of Notre Dame Australia, Fremantle WA 6959, Australia; Shane.Patman{at}

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Commentary on: Boden I, Skinner EH, Browning L, et al. Preoperative physiotherapy for the prevention of respiratory complications after upper abdominal surgery: pragmatic, double blinded, multicentre randomised controlled trial. BMJ 2018;360:j5916.


Upper abdominal surgery (UAS) triggers pathophysiological responses, potentially causing postoperative pulmonary complications (PPCs). Anaesthesia and surgery duration along with nociception depress mucociliary clearance and suppress the cough, contributing to reduced lung volumes and secretion retention, thereby contributing to atelectasis, impaired respiratory function and the development of infection.1 Additionally, patient-dependent parameters such as anxiety levels and willingness to participate, along with postoperative factors such as pain, create significant barriers to treatment and promote PPC development.1 The presence of PPCs following UAS negatively impacts morbidity and mortality, especially within the first week postoperatively.2 3 As a strategy to prevent PPCs, preoperative physiotherapy assessment and education for those subject to ‘at-risk’ surgery, such as cardiothoracic and UAS, was regular in the later part of …

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