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Pulmonary rehabilitation: a challenging exercise?
P143 Exploration of patient activity levels following thoracotomy and lung resection
  1. P Agostini1,
  2. H Cieslik1,
  3. B Naidu1,
  4. S Singh2
  1. 1Heart of England NHS Foundation Trust, Birmingham, UK
  2. 2Coventry University, Coventry, UK

Abstract

Background Reduced activity is a routine observation following major surgery, however no studies have yet measured or explored this. Causative factors include sedative drugs, reduced exercise tolerance and pain, as well as pre-existing pathology. We aimed to measure postoperative activity and observe outcomes of thoracotomy and lung resection patients, as well as identify predictive factors.

Methods A prospective observational study was conducted in a regional thoracic surgery centre. Sense Wear Pro 3 armbands were worn by patients from postoperative day (POD) 1 to 4. Postoperative physiotherapy included early mobilisation, which was progressed daily.

Results 99 patients were observed, 46 male (46%) and 92 (93%) had lung cancer. Mean (SD) age was 67 (±10) years and percentage predicted FEV1 75% (±19). During PODs 2/3 patients took a median (IQR) of 472 (908) steps with >99% of time spent in sedentary activity (<3 METs). Low activity was defined as <500 steps during PODs 2/3 (n=50), and high activity >500 steps (n=49). Patients with lower activity demonstrated a median of only 220 (282) steps compared to 1128 (960) in more active patients (p<0.001), less time spent in moderate activity >3 METS (p=0.003) and more perceived pain during PODs 2/3 (p=0.013 and 0.004 respectively). Frequency of postoperative pulmonary complication (PPC) was 4% (n=2) vs 20% (n=10) (p=0.34) in patients with lower activity, with a median LOS of 6 (3) days vs 5 (2) days (p=0.013). Logistic regression identified age =75 years, predicted FEV1 <70% and poor preoperative activity to be predictive of reduced postoperative activity, and COPD predictive of PPC (p<0.05).

Conclusion Low activity levels following thoracotomy are common despite regular physiotherapy; studies measuring pre and postoperative activity are needed to reveal the exact impact of surgery. It is not known whether reduced activity may cause PPC, or vice versa, and studies randomising patients to lower/ higher activity are needed to confirm this. Predictive factors could potentially be modified by preoperative physiotherapy/rehabilitation, and targeted postoperative exercise and escalation of analgesia may also be beneficial, however, evaluation of these strategies is required.

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