[Preparing for thoraco-abdominal surgery: What's in it for the physiotherapist?]

Abstract

Introduction: Physiotherapy before thoraco-abdominal surgery aims to optimize the patient's cardiorespiratory fitness, in order to limit his alterations in the immediate postoperative period and to reduce postoperative morbidity. This support also aims to make eligible for surgery the patient who is not initially. This review of the literature addresses chest physiotherapy and exercise training that the patient can benefit.

State of art: Scientific evidence remains relatively weak for physiotherapy before thoraco-abdominal surgery, especially for bronchial drainage and incentive spirometry techniques. However, inspiratory muscle training and prehabilitation seem interesting for increasing exercise capacity and reducing morbidity. These last two innovative modalities that can be carried out at home are particularly relevant for patients who present a high risk of complications or who cannot access conventional programs. Smoking cessation, nutritional care and educational support are areas that the physiotherapist must integrate into his practice.

Perspectives: In a decisional algorithm, we suggest 4 types of programs ranging from a simple preoperative education to an intensive multimodal program. This remains to be evaluated in current practice.

Conclusions: The physiotherapist must fully participate in assessing the risk of postoperative morbidity in the context of thoraco-abdominal surgery. He must also identify the most efficient modalities within the delay imposed by the date of surgery. It is also necessary that the latter learn to identify the patient at higher risk of postoperative complications in order to adapt the preoperative management according to the levels of scientific evidence.

Keywords: Chirurgie thoraco-abdominale; Complications postopératoires; Kinésithérapie; Physical therapy; Postoperative complications; Prehabilitation; Préhabilitation; Thoraco-abdominal surgery.