Impact of Preoperative Respiratory and Physical Therapy on Postoperative Pulmonary Function and Complications in Obese Patients Undergoing Laparoscopic Upper Abdominal Surgery

Abstract

Background:Obesity is an important risk factor for postoperative pulmonary complications (PPCs), especially for upper abdominal laparoscopic surgery. Prehabilitation, involving systematic physical and respiratory therapy has been found to improve perioperative outcomes but has not been thoroughly investigated in obese patients. Objective:To assess the effects of preoperative respiratory and physical therapy on postoperative pulmonary function and the occurrence of pulmonary complications among obese patients who are undergoing laparoscopic upper abdominal surgery. Methodology:A randomized controlled trial was conducted at Ayub Medical Complex, Abbottabad from April 2022 to January 2024. Sixty patients who were obese (BMI ≥30 kg/m², age ≥50 years) and undergoing elective laparoscopic cholecystectomy, fundoplication, or sleeve gastrectomy were randomly assigned to an intervention group (n=30) and a control group (n=30). Results:The intervention group had significantly improved postoperative pulmonary function at all time points (e.g., FVC on POD5: 2.6 ± 0.3 L vs. 2.0 ± 0.4 L, p<0.01). Secondary outcomes were also in the intervention's favor, such as lower oxygen requirement (17.4±4.9 vs. 26.2±6.1 hours, p<0.01), less hospital stay (4.3±1.1 vs. 5.7±1.3 days, p<0.01), decreased pain scores (VAS 3.5±0.9 vs. 4.9±1.2, p<0.01), and faster ambulation (9.1±2.3 vs. 13.5±3.1 hours, p<0.01). ICU admission rates were decreased but not statistically significant. Conclusion:Preoperative structured physical and respiratory therapy has been proven to improve postoperative pulmonary function and recovery and decrease PPCs in obese surgical patients having laparoscopic upper abdominal surgery. These results endorse the incorporation of prehabilitation into perioperative care pathways for high-risk surgical candidates.