Role of Incentive Spirometry as a Part of ERAS Protocol in Prevention of Postoperative Pulmonary Complications after Major Abdominal Surgery

Muhammad Fawad; Muhammad Tabish Iqbal; Abdul Hameed; Jawad Hameed; Sohail Akram; Shakeel Ahmed Zia

doi:10.70749/ijbr.v3i3.759

Authors

Muhammad Fawad Combined Military Hospital, Kohat, Pakistan.
Muhammad Tabish Iqbal Combined Military Hospital, Kharian, Pakistan.
Abdul Hameed Combined Military Hospital, Nowshehra, Pakistan.
Jawad Hameed Combined Military Hospital, Kharian, Pakistan.
Sohail Akram Combined Military Hospital, Kohat, Pakistan.
Shakeel Ahmed Zia Combined Military Hospital, Kohat, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v3i3.759

Keywords:

Incentive Spirometry, ERAS, Postoperative Pulmonary Complications, Abdominal Surgery, Perioperative Care, Hospital Stay, Fluid Management

Abstract

Background: Postoperative pulmonary complications (PPCs) significantly impact morbidity and healthcare burden after major abdominal surgeries. Enhanced Recovery After Surgery (ERAS) protocols have improved surgical outcomes, but the role of incentive spirometry (IS) as an adjunct in ERAS remains underexplored. Objective: To evaluate the efficacy of incentive spirometry within the ERAS framework in reducing PPCs, total fluid administration, and hospital length of stay (LOS) in patients undergoing major abdominal surgery. Methods: This quasi-experimental study was conducted at CMH Rawalpindi from June 2022 to March 2023 (ERC #393). A total of 182 patients (n = 91 per group), aged 18–60 years (ASA I–III), scheduled for elective major abdominal surgeries were included. Patients were allocated to the ERAS plus IS group (Group-IS) or conventional care group (Group-C). PPCs, perioperative fluid administration, and LOS were assessed using clinical and radiological parameters. Data were analyzed using SPSS (version 23), with statistical significance set at p ≤ 0.05. Results: PPC incidence was significantly lower in Group-IS (1.1%) than in Group-C (7.7%) (p = 0.03). Group-IS had significantly reduced perioperative fluid administration (1509 ± 178.23 mL vs. 2300 ± 256.23 mL, p = 0.000) and shorter LOS (1.44 ± 0.89 vs. 2.29 ± 0.87 days, p = 0.000). Conclusion: Incentive spirometry as part of the ERAS protocol significantly reduces PPCs, optimizes fluid management, and shortens LOS in major abdominal surgery, demonstrating clinical and economic benefits.

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