The Science Journal of the American Association for Respiratory Care

2006 OPEN FORUM Abstracts

A COMPARITIVE STUDY OF PRE OP INSTRUCTION VERSUS NO INSTRUCTION IN PATIENTS HAVING THORACIC OR ABDOMINAL SURGERY

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Jim Rebel, RRT, David Mussetter, BA, RRT, Tim Frymyer, BS, RRT, Mike Trevino, MS, RRT, Gary Weinstein, MD, FCCP, Presbyterian Hospital of Dallas, Dallas, Texas

Background: Our hospital is a 903 bed acute care teaching facility in a major metropolitan area. Under our protocol driven clinical practice model, the therapist is allowed to evaluate, order, modify, and discontinue therapy. As part of the protocol system patients having thoracic or non-laproscopic abdominal surgeries are evaluated and instructed on post-op respiratory therapy. The instruction is given the day of surgery, usually within two hours prior to the operating room. The patient is instructed on the purpose and proper technique of positive expiratory pressure (PEP) therapy. The treatments are restarted once the patient is admitted to the nursing unit post-operatively (post-op). We propose that pre-op instruction does not have meaningful input on the post-op recovery. 

Method: The data was collected via a retrospective review of randomly selected patients over a six month period. The patient population included patients who either had thoracic or non-laparoscopic abdominal surgery. These patients were divided into groups, thoracic/abdominal surgery patients (A) with and (B) without pre-op teaching. The groups were then evaluated using three simple outcome criteria: (1) worsening post-op chest x-ray (CXR) from initial post-op CXR, (2) number of respiratory treatments (tx.'s) received post-op, and (3) length of stay (LOS). There were 18 patients excluded for: (1) no comparison data for CXR or oxygenation [5], (2) no respiratory therapy treatment within 24 hours of extubation [1], (3) requiring greater than 24 hours of mechanical ventilation post-op [9], (4) experiencing more than one surgery during their current hospital admission [2], or 5) not being initially admitted for surgery [1].

Results:
  n = Worsening CXR Number of tx.'s Avg. LOS
Group (A) Pre-op instruction 32 36%  (10 of 28) 7.9 9.0
Group (B)  No pre-op instruction 47 19%  (7 of 36) 7.6 7.4

Thoracic surgical patients made up 87.5% of the group A and 63.8% of group B, while abdominal surgical patients made up 12.5% and 36.2% of each group respectively. Outcome data for group A did not reflect advantageous results over group B.

Conclusion: Although pre-op teaching of respiratory therapy intuitively seems like an important piece of a comprehensive protocol, the results were disappointing. Certainly this review, albeit a small sample size, points to the lack of benefit pre-op teaching would seem to offer. However, these results may be skewed by the large number of thoracic surgery patients in the pre-op group. Given the initial data though, it seems that pre-op instruction may have no benefit in the post-op course. Therefore, we conclude that pre-op teaching for respiratory therapy has little relevance to patient outcomes and healthcare resources are better spent when focused on the post-op care.


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