Perioperative care for major elective surgery: a survey of Brazilian physiotherapists

Resumo

Introduction: Major surgeries, such as upper abdominal, thoracic and cardiac surgeries are highly complex procedures. They have a higher incidence of respiratory morbidity and mortality compared to other types of surgery. In addition, postoperative pulmonary complications (PPC) are common after major surgeries and they are associated with increased hospital stay, health care costs and surgical patient mortality. Objective: To investigate the most commonly used physical therapy techniques for the prevention and treatment of PPC among thoracic and abdominal surgery patients in all regions of Brazil. Methods: A total of 489 randomly selected physiotherapists who provided perioperative care for patients undergoing elective abdominal, thoracic or cardiac surgeries participated in this study. A questionnaire with nine questions about routine care and therapeutic choices for the surgical population was developed and assessed by 10 specialists before being administered to the physiotherapists. Results: Among the physiotherapists (63% with at least 5 years of experience with surgical patients), 50.9% considered the patient’s surgical risk in their treatment either always or often. A total of 53.8% of patients were treated by the physiotherapist following a physician’s prescription. The most mentioned physical therapy techniques used to prevent PPC were postoperative mobilization/exercises (59.3%), postoperative lung expansion techniques (52.8%) and preoperative advice (50.7%). In addition, 80.6% of the physiotherapists believe that incentive spirometry prevents PPC, while 72.8% expected this effect from positive airway pressure devices. Conclusion: Most physiotherapists in Brazil who work with surgical patients offer preoperative professional advice and use postoperative early mobilization and lung expansion techniques to prevent PPC. Most physiotherapists consider the patient's surgical risk during treatment. In addition, some physical therapy sessions are routinely performed preoperatively. One worrying aspect is that, due to the current legislation, physiotherapists in Brazil do not have full autonomy to initiate physical therapy care by themselves.