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Lookup NU author(s): Dr Christopher Snowden
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2020 Marlow LL et al. Background: Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of complications and death following surgery. Pulmonary complications are particularly prominent. Pulmonary rehabilitation is a course of physical exercise and education that helps people with COPD manage their condition. 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. 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). Methods: 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. This study was run in two UK centres (Oxford and Newcastle upon Tyne). Results: We determined that a full randomised controlled trial would not be feasible, due to failure to identify and recruit participants. We identified an unmet need to identify more effectively patients with COPD earlier in the surgical pathway. Service evaluations suggested that barriers to identification and recruitment would likely be the same across other UK hospitals. Conclusions: 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. 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. Trial registration: ISRCTN29696295, 31/08/2017
Author(s): Marlow LL, Lee AHY, Hedley E, Grocott MP, Steiner MC, Young JD, Rahman NM, Snowden CP, Pattinson KTS
Publication type: Article
Publication status: Published
Journal: F1000Research
Year: 2020
Volume: 9
Online publication date: 09/03/2020
Acceptance date: 09/03/2020
Date deposited: 03/02/2021
ISSN (electronic): 2046-1402
Publisher: F1000 Research Ltd
URL: https://doi.org/10.12688/f1000research.22040.1
DOI: 10.12688/f1000research.22040.1
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