title: Implementation of a guideline for physical therapy in the postoperative period of upper abdominal surgery reduces the incidence of atelectasis and length of hospital stay.
abstract: OBJECTIVE
  The aim of this study was to evaluate the effectiveness of implementing a physical therapy guideline for patients undergoing upper abdominal surgery (UAS) in reducing the incidence of atelectasis and length of hospital stay in the postoperative period.
  
  
  METHODS
  A "before and after" study design with historical control was used. The "before" period included consecutive patients who underwent UAS before guideline implementation (intervention). The "after" period included consecutive patients after guideline implementation. Patients in the pre-intervention period were submitted to a program of physical therapy in which the treatment planning was based on the individual experience of each professional. On the other hand, patients who were included in the post-intervention period underwent a standardized program of physical therapy with a focus on the use of additional strategies (EPAP, incentive spirometry and early mobilization).
  
  
  RESULTS
  There was a significant increase in the use of incentive spirometry and positive expiratory airway pressure after guideline implementation. Moreover, it was observed that early ambulation occurred in all patients in the post-intervention period. No patient who adhered totally to the guideline in the post-intervention period developed atelectasis. Individuals in the post-intervention period presented a shorter length of hospital stay (9.2±4.1 days) compared to patients in the pre-intervention period (12.1±8.3 days) (p<0.05).
  
  
  CONCLUSIONS
  The implementation of a physical therapy guideline for patients undergoing UAS resulted in reduced incidence of atelectasis and reduction in length of hospital stay in the postoperative period.
authors.affiliation: Rehabilitation Service, Hospital Sírio-Libanês, São Paulo, SP, Brazil; School of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: S
authors.initials: S
authors.lastname: Souza Possa
authors.affiliation: Rehabilitation Service, Hospital Sírio-Libanês, São Paulo, SP, Brazil.
authors.forename: C
authors.initials: C
authors.lastname: Braga Amador
authors.affiliation: Rehabilitation Service, Hospital Sírio-Libanês, São Paulo, SP, Brazil.
authors.forename: A
authors.initials: A
authors.lastname: Meira Costa
authors.affiliation: Rehabilitation Service, Hospital Sírio-Libanês, São Paulo, SP, Brazil.
authors.forename: E
authors.initials: E
authors.lastname: Takahama Sakamoto
authors.affiliation: Rehabilitation Service, Hospital Sírio-Libanês, São Paulo, SP, Brazil; Rehabilitation Service, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: C
authors.initials: C
authors.lastname: Seiko Kondo
authors.affiliation: Rehabilitation Service, Hospital Sírio-Libanês, São Paulo, SP, Brazil; Physical Therapy Service, Hospital Sírio-Libanês, São Paulo, Brazil.
authors.forename: A L
authors.initials: AL
authors.lastname: Maida Vasconcellos
authors.affiliation: Rehabilitation Service, Hospital Sírio-Libanês, São Paulo, SP, Brazil.
authors.forename: C M
authors.initials: CM
authors.lastname: Moran de Brito
authors.affiliation: Rehabilitation Service, Hospital Sírio-Libanês, São Paulo, SP, Brazil. Electronic address: wellington.psyamaguti@hsl.org.br.
authors.forename: W
authors.initials: W
authors.lastname: Pereira Yamaguti
mesh_terms: D000005:Abdomen / Q000601:surgery*; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D011182:Postoperative Care; D017410:Practice Guidelines as Topic; D001261:Pulmonary Atelectasis / Q000453:epidemiology* / Q000517:prevention & control*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Atelectasia pulmonar; Cuidados pós-operatórios; Deambulação precoce; Early ambulation; Guideline; Hospitalization; Internamento; Modalidades de fisioterapia; Orientação; Physical therapy modalities; Postoperative care; Pulmonary atelectasis