Evaluation of preoperative risk assessment and pulmonary rehabilitation for prevention of postoperative pulmonary complications

2019 Fiscal Year Final Research Report

• Project/Area Number: 16K21045
• Research Category: Grant-in-Aid for Young Scientists (B)
• Allocation Type: Multi-year Fund
• Research Field: Medical and hospital managemen; Epidemiology and preventive medicine
• Research Institution: Niigata University
• Principal Investigator: Hokari Satoshi 新潟大学, 医歯学総合病院, 特任助教 (00771213)
• Project Period (FY): 2016-04-01 – 2020-03-31
• Keywords: 術後呼吸器合併症 / 呼吸リハビリテーション / 術後肺炎 / 術後呼吸不全 / スクリーニング / リスク指数

Outline of Final Research Achievements

This study verified two points: (1) validity of preoperative screening using respiratory failure risk index (RFRI), and (2) preventive effect of postoperative pulmonary complications (PPC) by perioperative pulmonary rehabilitation for patients with high risk of PPC.
Preoperative screening using RFRI made it possible to perform efficient perioperative pulmonary rehabilitation for high-risk patients. On the other hand, the preventive effect of PPC by pulmonary rehabilitation were not shown. It was suggested that the causes were invasiveness of thoracotomy and postoperative swallowing dysfunction.
In the future, a more multidisciplinary approach is required, mainly targeting thoracic surgery such as esophagectomy and including oral care and swallowing rehabilitation.

Free Research Field

呼吸器内科学

Academic Significance and Societal Importance of the Research Achievements

胸部手術において術後呼吸器合併症予防のための周術期呼吸リハビリの有効性は示されていたが，腹部手術に対してはその有効性が示された報告は少なく，介入対象について検討が必要とされていた．また，人的資源の有効活用や医療経済的な面からも効率的なハイリスク例の抽出および介入が求められていた．
今回の研究において，簡便に算出可能な多因子リスクスコアである呼吸不全リスク指数を用いた術前スクリーニングを行うことで，術後呼吸器合併症のハイリスク群に絞って効率的に周術期呼吸リハビリを行うことが可能であった．実臨床の場ですぐに適応可能な知見であり，その学術的・社会的意義は大きい．