title: Preoperative intervention reduces postoperative pulmonary complications but not length of stay in cardiac surgical patients: a systematic review.
abstract: OBJECTIVE
  Does preoperative intervention in people undergoing cardiac surgery reduce pulmonary complications, shorten length of stay in the intensive care unit (ICU) or hospital, or improve physical function?
  
  
  METHODS
  Systematic review with meta-analysis of (quasi) randomised trials.
  
  
  METHODS
  People undergoing coronary artery bypass grafts and/or valvular surgery.
  
  
  METHODS
  Any intervention, such as education, inspiratory muscle training, exercise training or relaxation, delivered prior to surgery to prevent/reduce postoperative pulmonary complications or to hasten recovery of function.
  
  
  METHODS
  Time to extubation, length of stay in ICU and hospital (reported in days). Postoperative pulmonary complications and physical function were measured as reported in the included trials.
  
  
  RESULTS
  The 17 eligible trials reported data on 2689 participants. Preoperative intervention significantly reduced the time to extubation (MD -0.14 days, 95% CI -0.26 to -0.01) and the relative risk of developing postoperative pulmonary complications (RR 0.39, 95% CI 0.23 to 0.66). However, it did not significantly affect the length of stay in ICU (MD -0.15 days, 95% CI -0.37 to 0.08) or hospital (MD -0.55 days, 95% CI -1.32 to 0.23), except among older participants (MD -1.32 days, 95% CI -2.36 to -0.28). When the preoperative interventions were separately analysed, inspiratory muscle training significantly reduced postoperative pulmonary complications and the length of stay in hospital. Trial quality ranged from good to poor and considerable heterogeneity was present in the study features. Other outcomes did not significantly differ.
  
  
  CONCLUSIONS
  For people undergoing cardiac surgery, preoperative intervention reduces the incidence of postoperative pulmonary complications and, in older patients, the length of stay in hospital.
authors: Department of Physiotherapy, Monash Medical Centre.
authors: David
authors: D
authors: Snowdon
authors: Allied Health Research Unit, Monash Health.
authors: Terry P
authors: TP
authors: Haines
authors: Department of Physiotherapy, Monash Medical Centre; Allied Health Research Unit, Monash Health; Department of Physiotherapy, Monash Health, Western Health, Melbourne, Australia.
authors: Elizabeth H
authors: EH
authors: Skinner
mesh_terms: D000368:Aged; D001945:Breathing Exercises; D058385:Cardiac Valve Annuloplasty; D002318:Cardiovascular Diseases / Q000601:surgery; D001026:Coronary Artery Bypass; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000517:prevention & control; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000517:prevention & control; D016896:Treatment Outcome
keywords: Cardiac surgical procedures; Coronary artery bypass; Education; Preoperative care; Rehabilitation