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Is Physiotherapy routinely required following video-assisted thoracoscopic surgery (VATS)?

Is Physiotherapy routinely required following video-assisted thoracoscopic surgery (VATS)?. SCTS Forum presentation #938 March 27 th 2015 P Agostini , K Massey, M Kalkat , PB Rajesh, RS Steyn , B Naidu, E Bishay. Postoperative Physiotherapy- Thoracic Surgery. -High risk patients

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Is Physiotherapy routinely required following video-assisted thoracoscopic surgery (VATS)?

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  1. Is Physiotherapy routinely required following video-assisted thoracoscopic surgery (VATS)? SCTS Forum presentation #938 March 27th 2015 P Agostini, K Massey, M Kalkat, PB Rajesh, RS Steyn, B Naidu, E Bishay

  2. Postoperative Physiotherapy- Thoracic Surgery -High risk patients -Prevention/ treatment PPC • Sit out of bed POD 1 • Mobilise POD 1 • Progression to exercise- frequency/duration/task • Sputum clearance • Increase lung volume

  3. VATS - Background • Minimally invasive surgery/ VATS • reduces LOS/complication/ • Less painful • Less surgical attachments/ Increases mobility • Conflicting evidence re reduction of pneumonia? • Varying frequency reported • No published studies rehab/physiotherapy following VATS • Anecdotal evidence suggests physiotherapy may not always be required

  4. VATS- Physiotherapy practice UK 31/40 • Variable practice following VATS • 35% routine contact • 13% no routine contact • 52% smokers, elderly, mobility, pulmonary • Vs 97% routine physiotherapy post- thoracotomy

  5. VATS lobectomy -SCTS 2013 • HEFT - VATS lobectomy (n=123) ; • left hospital earlier (4 vs 6 days p<.001) • significantly less PPC (7% vs 23% p=.025) • fewer physiotherapy sessions (p=.005) and less time (p<.001) • BUT • 70% (38) –early mobility required considerable assistance • 41% (22) –mobility/ respiratory problems beyond PODs 1/2 • Routine Physiotherapy consequently maintained

  6. AIMS Question: Is routine physiotherapy necessary following ALLVATS? STUDY AIMs 1. To observe the physiotherapeutic requirements, both respiratory and mobility, of patients undergoing minor VATS procedures 2. Observe frequency of PPC development to establish if there is a role in prevention

  7. Patients and Methods • Feb-Sept 2013 • All patients undergoing VATS observed prospectively • Exclusions- lobectomy/LVRS/decortication • POD1 patients screened by Physiotherapists on ward round • If triage revealed... • chronic lung disease (CLD) • decreased mobility • elderly • increased bronchial secretions • oxygen saturations <92% ...patients were fully assessed to ascertain physiotherapy needs • MDT aware of screening -able to easily refer patients with specific problems as , when and if necessary

  8. The triage screening process was based on anecdotal evidence and risk factors for development of PPC following thoracotomy

  9. Results • n=261 screened by Physiotherapists • wedge resection (156) • pleural procedures (50) • bullectomy/ pleurectomy (37) • mediastinal procedures (12) • other (6) • After triage 42 patients (16%) received full physiotherapy assessment, 35 (13%) needed specific treatments • 12 CLD • 15 pulmonary -2 developed pneumonia (0.7%) • 8 mobility

  10. A further 7 (3%) patients (not originally assessed) were later referred by MDT PODs 1-6 for specific treatments • 5 pulmonary • 2 mobility (1 stairs) • In total 42 patients (16%) needed physiotherapy • 12 CLD • 20 pulmonary • 10 mobility • No link with operative procedure Triage correctly identified 83% (35/42)

  11. Importance • BOTTOM LINE- 84% DID NOT receive physiotherapy assessment and WERE NOT re-referred with any problems • Re-direction of resources- staff/time • 28 contacts per month • 1- 1.5hr/ day • Enhanced recovery • Early mobilisation • Thoracotomy/ Chest wall patients

  12. Conclusion • Routine physiotherapy is unnecessary following minor VATS • Few patients developed PPC- no preventative role • The triage/ screening system successfully identified the majority of patients with mobility/ pulmonary problems, with few subsequent referrals • Change in practice- more time for higher risk patients , PPC and early mobilisation

  13. Questions?

  14. Postoperative Physiotherapy Humidification/ nebulisation Deep breathing techniques Analgesia Analgesia Lung volume Sputum Early mobility/ Exercise Exercise Breathing techniques Huff/ cough Positioning Sputum clearance Improve lung volume

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