COMPARATIVE IMPACT OF LAPAROTOMY AND THORACOSTOMY ON RPP OF PATIENTS: A GUIDE TO POSTSURGICAL PHYSIOTHERAPY PRESCRIPTION BY
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Abstract
Background:
Laparotomy and thoracostomy are major invasive procedures that impose distinct physiological stresses on the cardiovascular system. The rate-pressure product (RPP), an index of myocardial oxygen demand, provides a reliable measure of cardiovascular workload following surgical interventions. Understanding how these procedures influence RPP is essential for physiotherapists
in planning safe and effective post-surgical rehabilitation.
Methods:
An observational prospective cohort design was employed. Forty surgical patients with a mean age (CTTD: 44.0 ± 12.43 years; Laparotomy: 42.4 ± 23.12 years) were recruited through simple random sampling and assigned to two groups: laparotomy (n = 20) and closed-tube thoracostomy drainage (CTTD) (n = 20). Cardiovascular parameters—systolic blood pressure (SBP) and pulse rate (PR)—were recorded preoperatively and at 24, 48, and 72 hours postoperatively using an automated monitor. RPP was computed as SBP × PR. Pain intensity was assessed using the Visual Analogue Scale (VAS). Data were analyzed using descriptive statistics, paired and independent t-tests, and repeated measures ANOVA, with significance set at p < 0.05.
Results:
Thirty-one patients (20 laparotomy, 11 CTTD) completed the study. Baseline SBP, PR, and RPP were comparable between groups. Both groups exhibited postoperative fluctuations in SBP and PR, yet RPP remained relatively stable across all time points. Paired t-tests revealed no significant changes in RPP within groups, though the laparotomy group showed significant reductions in PR at 24 and 48 hours (p < 0.001). Repeated measures ANOVA confirmed no significant time effect on RPP in either group (CTTD: F (3, 30) = 0.929, p = 0.439; laparotomy: F (3,57) = 1.536, p = 0.215). Between-group comparisons showed no significant RPP differences at any interval (p > 0.05). Mean VAS scores were similar (CTTD: 3.00 ± 0.82; laparotomy: 3.20 ± 0.76).
Conclusion:
Laparotomy and thoracostomy procedures exert comparable effects on myocardial workload, as indicated by stable RPP values across postoperative periods. These findings suggest that cardiovascular responses following both surgeries are similar and that physiotherapy prescriptions should be guided by individualized patient assessment rather than procedure type alone.
Keywords:
Laparotomy, Thoracostomy, Rate Pressure Product, Myocardial Workload, Postoperative Physiotherapy, Cardiovascular Response.
Laparotomy and thoracostomy are major invasive procedures that impose distinct physiological stresses on the cardiovascular system. The rate-pressure product (RPP), an index of myocardial oxygen demand, provides a reliable measure of cardiovascular workload following surgical interventions. Understanding how these procedures influence RPP is essential for physiotherapists
in planning safe and effective post-surgical rehabilitation.
Methods:
An observational prospective cohort design was employed. Forty surgical patients with a mean age (CTTD: 44.0 ± 12.43 years; Laparotomy: 42.4 ± 23.12 years) were recruited through simple random sampling and assigned to two groups: laparotomy (n = 20) and closed-tube thoracostomy drainage (CTTD) (n = 20). Cardiovascular parameters—systolic blood pressure (SBP) and pulse rate (PR)—were recorded preoperatively and at 24, 48, and 72 hours postoperatively using an automated monitor. RPP was computed as SBP × PR. Pain intensity was assessed using the Visual Analogue Scale (VAS). Data were analyzed using descriptive statistics, paired and independent t-tests, and repeated measures ANOVA, with significance set at p < 0.05.
Results:
Thirty-one patients (20 laparotomy, 11 CTTD) completed the study. Baseline SBP, PR, and RPP were comparable between groups. Both groups exhibited postoperative fluctuations in SBP and PR, yet RPP remained relatively stable across all time points. Paired t-tests revealed no significant changes in RPP within groups, though the laparotomy group showed significant reductions in PR at 24 and 48 hours (p < 0.001). Repeated measures ANOVA confirmed no significant time effect on RPP in either group (CTTD: F (3, 30) = 0.929, p = 0.439; laparotomy: F (3,57) = 1.536, p = 0.215). Between-group comparisons showed no significant RPP differences at any interval (p > 0.05). Mean VAS scores were similar (CTTD: 3.00 ± 0.82; laparotomy: 3.20 ± 0.76).
Conclusion:
Laparotomy and thoracostomy procedures exert comparable effects on myocardial workload, as indicated by stable RPP values across postoperative periods. These findings suggest that cardiovascular responses following both surgeries are similar and that physiotherapy prescriptions should be guided by individualized patient assessment rather than procedure type alone.
Keywords:
Laparotomy, Thoracostomy, Rate Pressure Product, Myocardial Workload, Postoperative Physiotherapy, Cardiovascular Response.
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