Physiotherapy Following Emergency Abdominal Surgery

Physiotherapy following elective abdominal surgery has been well documented, but following emergency abdominal surgery, despite poorer outcomes and increased complication rates, physiotherapy interventions for this patient group remain largely uninvestigated. The most common complication following upper abdominal surgery is the development of a post-operative pulmonary complication (PPC). Risk factors for the development of PPCs include duration of anaesthesia, emergency upper abdominal surgery, current smoker status, respiratory comorbidities, obesity, increased age and multiple surgeries. Physiotherapy interventions aim to prevent or remediate PPCs and post-operative complications associated with the sequelae of immobility such as venothrombotic events and to facilitate recovery from surgery and a return to normal activities of daily living and function. Physiotherapy interventions after major surgery include early mobilisation and respiratory physiotherapy techniques. Respiratory therapies include deep breathing and coughing exercises, positive expiratory pressure devices, incentive spirometry and non-invasive ventilation. Early mobilisation has been demonstrated to be safe and efficacious following elective abdominal surgery and for patients who are critically ill. This chapter reviews the evidence in these populations and propose that, until further studies are available to direct care, this evidence is extrapolated to patients following emergency abdominal surgery. As abdominal surgery impacts on physical recovery and health-related quality of life, post-discharge rehabilitation programmes may improve long-term outcomes; however, rehabilitation following major cavity surgery is in its infancy. This chapter investigates post-operative rehabilitation research to date in this population in an attempt to determine the effectiveness of such programmes and make recommendations for future practice.