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Centre for Evidence-
Based Medicine

Upper Abodominal Surgery - Periop physio decreases postop pulmonary complications

Clinical Bottom Line

Perioperative physio decreases post-op pulmonary complications in patients undergoing upper abdominal surgery (NNT=5).


Fagevik Olsen M, Hahn I, Nordgren S, Lonroth H, Lundholm K. Randomized controlled trial of prophylactic chest physiotherapy in major abdominal surgery. British Journal of Surgery 1997;84:1535-1538.

Clinical Question

Is prophylactic physiotherapy for patients undergoing upper abdominal surgery effective in preventing post-operative pulmonary complications?

Search Terms

physical therapy (MeSH), postoperative pulmonary complications (textword) were used to search the current MEDLINE file

The Study

  • Non-blinded non-randomised trial without intention-to-treat.
  • The Study Patients: Series of 368 consecutive patients aged 19-92 (mean 53.4 years) undergoing elective open abdominal surgery in Goteborg, Sweden. The baseline characteristics (sex, age, height, weight, smoking status, existing lung disease, high risk status, and American Society of Anesthesiologists score) were similar in both groups. The study design was described as randomized but used alternation by month.
  • Control group (N = 194; 192 analysed): Patients did not receive any information or training
  • Experimental group (N = 174; 172 analysed): Patients were seen the day before surgery and post operatively and given information and training. The training consisted of pursed lip breathing exercises, huffing, and coughing to be done hourly as well as information about positioning changes while in bed and early mobilization. High risk patients received positive respiratory pressure (PEP) masks. Patients were told to take 30 deep breaths with huffing and coughing after every 10th breath every hour during the daytime after the surgery. The duration of physiotherapy was 10-15 minutes prior to surgery and 15-20 minutes after the operation.

The Evidence

Outcome Time to Outcome CER EER RR ARR NNT
Post-operative pulmonary complication PPC(all patients) 1-6 days 27% 6% 79% 21% 5
95% Confidence Intervals: 52% to 100% 14% to 29% 4 to 8
PPC (high risk patients) PPC (high risk patients) 51% 15% 71% 36% 3
95% Confidence Intervals: 33% to 100% 17% to 56% 2 to 6
Pneumonia (all patients) 1-6 days 0.068 0.006 91% 6% 17
95% Confidence Intervals: 36% to 100% 3% to 10% 11 to 41


  1. The limitations of the study were lack of true randomisation (alternation by month was used) and lack of blind outcome assessment.
  2. A post-operative pulmonary complication was defined as oxygen saturation less than 92% OR two of the following three criteria: temperature greater than 38.2 degrees C, auscultation findings and x-ray changes.

Appraised By

Jean Crowe, Mary Ann O'Brien; January 1999

Expiry Date

Update By: January 2001.