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      Is incentive spirometry beneficial for patients with lung cancer receiving video-assisted thoracic surgery?

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          Abstract

          Background

          The effectiveness of Incentive spirometry (IS) in patients undergoing video-assisted thoracic surgery (VATS) remains lacking. We conducted a population-based study to investigate the effectiveness of IS on patients with lung cancers following VATS.

          Methods

          We identified patients newly diagnosed with lung cancer who underwent surgical resection by VATS or thoracotomy from the years 2000 to 2008 in the Longitudinal Health Insurance Database. Exposure variable was the use of IS during admission for surgical resection by VATS or thoracotomy. Primary outcomes included hospitalization cost, incidence of pneumonia, and length of hospital stay. Secondary outcomes included the frequency of emergency department (ED) visits and hospitalizations at 3-month, 6-month, and 12-month follow-ups after thoracic surgery.

          Results

          We analyzed 7549 patients with lung cancer undergoing surgical resection by VATS and thoracotomy. The proportion of patients who were subjected to IS was significantly higher in those who underwent thoracotomy than in those who underwent VATS (68.4% vs. 53.1%, P < 0.0001). After we controlled for potential covariates, the IS group significantly reduced hospitalization costs (− 524.5 USD, 95% confidence interval [CI] = − 982.6 USD – -66.4 USD) and the risk of pneumonia (odds ratio = 0.55, 95% CI = 0.32–0.95) compared to the non-IS group following VATS. No difference in ED visit frequency and hospitalization frequency at 3-month, 6-month, and 1-year follow-up was noted between the IS and the non-IS groups following VATS.

          Conclusions

          The use of IS in patients with lung cancers undergoing VATS may reduce hospitalization cost and the risk of pneumonia.

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          Most cited references29

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          Strategies to reduce postoperative pulmonary complications after noncardiothoracic surgery: systematic review for the American College of Physicians.

          Postoperative pulmonary complications are as frequent and clinically important as cardiac complications in terms of morbidity, mortality, and length of stay. However, there has been much less research and no previous systematic reviews of the evidence of interventions to prevent pulmonary complications. To systematically review the literature on interventions to prevent postoperative pulmonary complications after noncardiothoracic surgery. MEDLINE English-language literature search, 1 January 1980 through 30 June 2005, plus bibliographies of retrieved publications. Randomized, controlled trials (RCTs); systematic reviews; or meta-analyses that met predefined inclusion criteria. Using standardized forms, the authors abstracted data on study methods, quality, intervention and control groups, patient characteristics, surgery, postoperative pulmonary complications, and adverse events. The authors qualitatively synthesized, without meta-analysis, evidence from eligible studies. Good evidence (2 systematic reviews, 5 additional RCTs) indicates that lung expansion interventions (for example, incentive spirometry, deep breathing exercises, and continuous positive airway pressure) reduce pulmonary risk. Fair evidence suggests that selective, rather than routine, use of nasogastric tubes after abdominal surgery (2 meta-analyses) and short-acting rather than long-acting intraoperative neuromuscular blocking agents (1 RCT) reduce risk. The evidence is conflicting or insufficient for preoperative smoking cessation (1 RCT), epidural anesthesia (2 meta-analyses), epidural analgesia (6 RCTs, 1 meta-analysis), and laparoscopic (vs. open) operations (1 systematic review, 1 meta-analysis, 2 additional RCTs), although laparoscopic operations reduce pain and pulmonary compromise as measured by spirometry. While malnutrition is associated with increased pulmonary risk, routine total enteral or parenteral nutrition does not reduce risk (1 meta-analysis, 3 additional RCTs). Enteral formulations designed to improve immune status (immunonutrition) may prevent postoperative pneumonia (1 meta-analysis, 1 additional RCT). The overall quality of the literature was fair: Ten of 20 RCTs and 6 of 11 systematic reviews were good quality. Few interventions have been shown to clearly or possibly reduce postoperative pulmonary complications.
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            Video-assisted thoracoscopic surgery lobectomy for lung cancer is associated with a lower 30-day morbidity compared with lobectomy by thoracotomy.

            Lung cancer is the most common cause of cancer-related deaths worldwide. Survival is highly dependent on surgery. Video-assisted thoracoscopic surgery (VATS) is increasingly chosen over open thoracotomy (OT) because of the possible benefits of the minimally invasive approach. Consequently, our aim was to compare the 30-day morbidity and mortality for lung cancer patients operated by VATS lobectomy or lobectomy by OT.
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              Effects of early mobilisation in patients after cardiac surgery: a systematic review

              Early mobilisation is prescribed after cardiac surgery to prevent postoperative complications, decrease length of hospital stay, and augment return to daily activities.
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                Author and article information

                Contributors
                jin2312@gmail.com
                wtsai@mail.cmu.edu.tw
                ccchu1530@gmail.com
                b8507006@gmail.com
                886-4-22294411 , albertchung5325@gmail.com , chung.w53@msa.hinet.net
                Journal
                BMC Pulm Med
                BMC Pulm Med
                BMC Pulmonary Medicine
                BioMed Central (London )
                1471-2466
                8 July 2019
                8 July 2019
                2019
                : 19
                : 121
                Affiliations
                [1 ]ISNI 0000 0001 0083 6092, GRID grid.254145.3, Department of Health Services Administration, , China Medical University, ; Taichung, Taiwan
                [2 ]ISNI 0000 0001 0083 6092, GRID grid.254145.3, Department of Public Health, , China Medical University, ; Taichung, Taiwan
                [3 ]ISNI 0000 0001 0083 6092, GRID grid.254145.3, Department of Respiratory Therapy, , China Medical University, ; Taichung, Taiwan
                [4 ]ISNI 0000 0004 0572 9415, GRID grid.411508.9, Division of Respiratory Therapy, , China Medical University Hospital, ; Taichung, Taiwan
                [5 ]ISNI 0000 0004 0532 2121, GRID grid.411649.f, Department of Biomedical Engineering, , Chung Yuan Christian University, ; Jhongli, Taiwan
                [6 ]ISNI 0000 0004 0572 9415, GRID grid.411508.9, Management Office for Health Data, China Medical University Hospital, ; Taichung, Taiwan
                [7 ]GRID grid.454740.6, Department of Internal Medicine, Taichung Hospital, , Ministry of Health and Welfare, ; No. 199, Section 1, San-Min Road, Taichung City, 40343 Taiwan
                [8 ]ISNI 0000 0004 0639 2818, GRID grid.411043.3, Department of Healthcare Administration, , Central Taiwan University of Science and Technology, ; Taichung, Taiwan
                Article
                885
                10.1186/s12890-019-0885-8
                6615301
                31286923
                4140a4b2-1fa5-44a7-98f5-b09759d289c0
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 15 November 2018
                : 24 June 2019
                Funding
                Funded by: Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence
                Award ID: MOHW105-TDU-B-212-133019
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Respiratory medicine
                lung cancer,incentive spirometry,video-assisted thoracic surgery (vats)

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