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Post-Operative Outcomes of Pre-Thoracic Surgery Respiratory Muscle Training vs Aerobic Exercise Training: A Systematic Review and Network Meta-analysis

Published:December 17, 2022DOI:https://doi.org/10.1016/j.apmr.2022.10.015

      Abstract

      Objective

      To compare the postoperative outcomes of preoperative respiratory muscle training (RMT) with a device to preoperative aerobic exercise training (AET) in patients undergoing thoracic surgeries (cardiac and lung).

      Data Sources

      PubMed, EMBASE, Cochrane, and Web of Science were comprehensively searched upon inception to 9/2020.

      Study Selection

      All randomized control studies, including preoperative RMT and preoperative AET compared with a non-training control group, were included.

      Data Extraction

      The meta-analysis was performed for outcomes including postoperative pulmonary complications (PPC), pneumonia, postoperative respiratory failure (PRF), hospital length of stay (HLOS), and mortality. We performed a network meta-analysis based on Bayesian random-effects regression models.

      Data Synthesis

      A total of 25 studies, 2070 patients were included in this meta-analysis. Pooled data for the patients who performed RMT with a device showed a reduction in PPCs, pneumonia, PRF with odds ratio (OR) of 0.35 (P value .006), 0.38 (P value .002), and 0.22 (P value .008), respectively. Pooled data for the patients who performed AET showed reduction in PPC, pneumonia with a OR of 0.33 (P value <.00001) and OR of 0.54 (P value .01), respectively. HLOS was decreased by 1.69 days (P value <.00001) by performing RMT and 1.79 days (P value .0008) by performing AET compared with the usual group. No significant difference in all-cause mortality compared with usual care in both RMT and AET intervention groups. No significant difference in the incidence of PRF compared with usual group in RMT + AET and AET alone intervention groups (OR 0.32; P=.21; OR 0.94; P=.87). Based on rank probability plots analysis, on network meta-analysis, RMT and AET ranked similarly on the primary outcome of PPC and secondary outcomes of pneumonia, PRF and HLOS.

      Conclusions

      In thoracic surgeries, preoperative RMT is comparable with preoperative AET to prevent PPC, pneumonia, and PRF and reduce HLOS. It can be considered in patients in resource-limited settings.

      Keywords

      List of abbreviations:

      AET (aerobic exercise training), CI (confidence interval), HLOS (hospital length of stay), I2 (Heterogeneity), MD (mean difference), NMA (network meta-analysis), OR (odds ratio), PPC (postoperative pulmonary complications), PRF (postoperative respiratory failure), RMT (respiratory muscle training), SUCRA (surface under the cumulative ranking curve)
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