The Science Journal of the American Association for Respiratory Care

2000 OPEN FORUM Abstracts

PREOPERATIVE AND POSTOPERATIVE INCENTIVE SPIROMETRY TEACHING IN THE GENERAL SURGERY PATIENT: OUTCOME DIFFERENCES IN THE OCCURRENCE OF POSTOPERATIVE PULMONARY COMPLICATIONS

Rikki S. Bruinsma, RRT CPFT; Karen W. Hampton, RRT; St. Luke's Hospital, Jacksonville, FL

Hypothesis: Research has confirmed the use of an incentive spirometry (IS) device after undergoing general surgery has decreased the likelihood of developing postoperative pulmonary complications (i.e. atelectasis and pneumonia). We hypothesized there is no clear benefit of performing preoperative IS teaching with continued post-op monitoring over postoperative IS instruction and monitoring in preventing these complications. Background: The time period prior to surgery has often been referred to as an ideal "teachable moment" for the patient and family. Although the exact time frame has not been clearly identified, we believe the hour or so just prior to surgery is not the best time to "teach" the patient. This is often a time when pre-op preps are occurring, consents are being obtained, patients are discussing concerns with their families or are in prayer. Simply put, we feel the patient is too overwhelmed preoperatively to comprehend the importance of proper postoperative IS use. However, this is the time when many patients in our hospital are being instructed on the technique and benefits of incentive spirometry. Method: A retrospective random medical record review of 47 patients was performed. The criteria for inclusion in our study included patients being admitted to general surgical services between 06/01/99 and 12/31/99 with orders for incentive spirometry instruction.

Results:
The following table outlines the

Results:

Pre-op Instruction Post-op Instruction
Sample Size (Male / Female) 22 (11 /11) 25 (10 / 15)
Mean Age (Range) 60.2 years (52 ± 28) 60.7 years (58 ± 36)
Å Smoking History1 2 3
Å Pulmonary Disease2 2 2
Å Smoking Hx & Pulm Dx 2 1
Developed Post-op Atelectasis3 3 (13.6%) 3 (12%)
Developed Post-op Pneumonia4 1 (4.5%) 1 (4%)
1 Identified as a current smoker or someone who has quit < 5 years ago
2 From patient/family interview and includes asthma, bronchitis or emphysema
3 As identified by positive chest roentgenograph and a temperature < 38° C
4 As identified by positive chest roentgenograph and a temperature ³ 38° C

Statistical analysis by chi2 (p=.84) indicates there is no significant difference in the likelihood of developing postoperative pulmonary complications between the two groups.
Conclusion: Results have indicated there is no clear benefit of preoperative IS teaching with postoperative monitoring when compared to postoperative teaching and monitoring in preventing pulmonary complications after surgery. It was also noted that smoking and pulmonary history did not influence the outcome of this study.

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