What is the effect of preoperative education on postoperative pulmonary complications following upper abdominal surgery

A postoperative pulmonary complication (PPC) is more than 15 times more common following upper abdominal surgery (UAS) than a cardiac complication. A PPC more than doubles the baseline cost of abdominal surgery.1,2 A single PPC costs the hospital approximately $AUD 45 000 to treat.1 John Hunter Hospital is a major centre in NSW for UAS such as open gastro-oesophageal cancer resections, performing 384 UAS procedures in 2019. Due to the pathophysiological impact that these higher risk procedures have, PPCs are more likely to occur when compared to lower abdominal and non-thoracic surgeries.2,3 Prospective collection of PPCs in a group of patients undergoing UAS at JHH (n=48) between November 2021 and June 2022 demonstrated a rate of PPCs of 25%. An Australian/New Zealand multicentre randomized control trial (RCT) and economic analysis evaluated the impact of a simple 30-minute preoperative Physiotherapy education intervention for those undergoing high risk abdominal surgery.3 (ACTRN12613000664741) This intervention involved education related to postoperative pulmonary complications, their causes and implications, and the importance of deep breathing, coughing and early mobility in their prevention. This intervention resulted in a reduction in the incidence of PPC by half and an absolute risk reduction of PPC of 15%. 3 It is unclear how this research translates into clinical practice, particularly when preoperative flow may differ between health services and also when many perioperative appointments are now conducted via telehealth. This research aims to evaluate the feasibility of the pragmatic delivery of a 20 minute 1:1 physiotherapy preoperative education session (Boden et al 3) for people undergoing UAS at JHH and the impact on PPCs . We hypothesise, that more than 90% of patients eligible for this study will be delivered the preoperative education, and that a reduction in PPCs, similar to that reported by Boden et al 3, will be observed. 1. Fleisher LA, Linde-Zwirble WT. Incidence, outcome, and attributable resource use associated with pulmonary and cardiac complications after major small and large bowel procedures. Perioper Med (Lond). 2014;3:7. 2. Serpa Neto A, Hemmes SN, Barbas CS, et al. Incidence of mortality and morbidity related to postoperative lung injury in patients who have undergone abdominal or thoracic surgery: a systematic review and meta-analysis. Lancet Respir Med. 2014;2(12):1007-1015. 3. Boden I, El-Ansary D, Zalucki N, et al. Physiotherapy education and training prior to upper abdominal surgery is memorable and has high treatment fidelity: a nested mixed-methods randomised-controlled study. Physiotherapy. 2018;104(2):194-