Findings of a feasibility study of pre-operative pulmonary rehabilitation to reduce post-operative pulmonary complications in people with chronic obstructive pulmonary disease scheduled for major abdominal surgery.

[" Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of complications and death following surgery. Pulmonary complications are particularly prominent.\u00a0 Pulmonary rehabilitation is a course of physical exercise and education that helps people with COPD manage their condition.\u00a0 Although proven to improve health outcomes in patients with stable COPD, it has never been formally tested as a pre-surgical intervention in patients scheduled for non-cardiothoracic surgery.\u00a0 If a beneficial effect were to be demonstrated, pulmonary rehabilitation for pre-surgical patients with COPD might be rapidly implemented across the National Health Service, as pulmonary rehabilitation courses are already well established across much of the United Kingdom (UK). We performed a feasibility study to test study procedures and barriers to identification and recruitment to a randomised controlled trial testing whether pulmonary rehabilitation, delivered before major abdominal surgery in a population of people with COPD, would reduce the incidence of post-operative pulmonary complications.\u00a0 This study was run in two UK centres (Oxford and Newcastle upon Tyne). \u00a0 We determined that a full randomised controlled trial would not be feasible, due to failure to identify and recruit participants.\u00a0 We identified an unmet need to identify more effectively patients with COPD earlier in the surgical pathway.\u00a0 Service evaluations suggested that barriers to identification and recruitment would likely be the same across other UK hospitals. \u00a0 Although pulmonary rehabilitation is a potentially beneficial intervention to prevent post-operative pulmonary complications, a randomised controlled trial is unlikely to recruit sufficient participants to answer our study question conclusively at the present time, when spirometry is not automatically conducted in all patients planned for surgery.\u00a0 As pulmonary rehabilitation is a recommended treatment for all people with COPD, alternative study methods combined with earlier identification of candidate patients in the surgical pathway should be considered. ISRCTN29696295, 31\/08\/2017.",{"copyright":"Copyright: \u00a9 2020 Marlow LL et al."}]