Nuffield Division of Anaesthetics, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
Warwick Medical School, The University of Warwick, Coventry, UK.
F1000Res. 2020 Mar 9;9:172. doi: 10.12688/f1000research.22040.1. eCollection 2020.
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). 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). 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. 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. ISRCTN29696295, 31/08/2017.
慢性阻塞性肺疾病（COPD）患者在手术后发生并发症和死亡的风险增加。肺部并发症尤为突出。肺康复是一种身体锻炼和教育课程，可帮助 COPD 患者控制病情。尽管已证明它可改善稳定型 COPD 患者的健康结果，但从未在计划进行非心胸外科手术的患者中作为术前干预进行过正式测试。如果证明有益，则 COPD 术前患者的肺康复可能会在英国国民保健制度中迅速实施，因为肺康复课程在英国大部分地区已经得到很好的建立。我们进行了一项可行性研究，以测试研究程序以及确定和招募参加随机对照试验的障碍，该试验测试了在 COPD 人群中进行主要腹部手术之前进行肺康复是否会降低术后肺部并发症的发生率。这项研究在英国的两个中心（牛津和纽卡斯尔）进行。我们确定，由于未能确定和招募参与者，因此无法进行全面的随机对照试验。我们确定需要更有效地确定更早进入手术途径的 COPD 患者。服务评估表明，在其他英国医院中，识别和招募的障碍可能是相同的。尽管肺康复是预防术后肺部并发症的潜在有益干预措施，但目前在所有计划接受手术的患者中均未自动进行肺功能检查的情况下，进行随机对照试验不太可能招募足够的参与者来明确回答我们的研究问题。由于肺康复是所有 COPD 患者的推荐治疗方法，因此应考虑结合更早地确定手术途径中的候选患者的替代研究方法。ISRCTN29696295，2017 年 8 月 31 日。
