Role of preoperative Incentive Spirometry in prevention of postoperative pulmonary complications after abdominal surgery

Author(s): Maham Arshad, Azka Ashraf, Ghanwa Muzammil, Rohma Arshad, Awais Amjad Malik, Jehanzaib Rashid

Background: Postoperative pulmonary complications (PPCs) are a major cause of morbidity following abdominal surgeries, particularly midline laparotomies. Incentive spirometry (IS) promotes lung expansion and prevents PPCs. This study evaluates the effectiveness of preoperative IS in reducing PPCs in patients undergoing elective midline laparotomies lasting more than 2 hours, with consistent perioperative management by the same surgical and anesthesia teams.

Methods: A prospective, randomized controlled trial was conducted at Lahore General Hospital, involving 100 patients undergoing elective midline laparotomies. Patients were randomly assigned to an intervention group (preoperative and postoperative IS) or a control group (postoperative IS only). Postoperative oxygenation was monitored using PaO2 and SpO2, and PPCs (atelectasis, pneumonia, pleural effusion) were diagnosed clinically and radiologically. Secondary outcomes included hospital stay, postoperative pain (VAS), and time to first mobilization.

Results: The intervention group had a significantly lower incidence of PPCs (10% vs. 26%, p = 0.01) and greater postoperative oxygenation improvement (PaO2 increase: 18% vs. 10%, p = 0.02). Hospital stays were shorter (6 vs. 9 days, p = 0.01), pain scores lower (VAS: 3.0 vs. 4.2 at 48 hours, p = 0.02), and mobilization earlier (28 vs. 36 hours, p = 0.03).

Conclusions: Preoperative IS effectively reduces PPCs, improves oxygenation, shortens hospital stays, and promotes faster mobilization. Routine preoperative IS should be integrated into surgical protocols, particularly in resource-limited settings, to optimize patient outcomes.