# Preoperative respiratory training with incentive spirometry for the prevention of pulmonary complications after liver surgery- a randomized pilot trial (PreSpi Trial)

## TL;DR

A pilot study found that preoperative respiratory training with an incentive spirometer reduced postoperative pulmonary complications in liver surgery patients.

## Contribution

This is the first pilot trial to demonstrate the feasibility and potential effectiveness of short-term, self-conducted preoperative respiratory training in reducing postoperative pulmonary complications.

## Key findings

- Zero intervention patients developed pneumonia compared to 25% in the control group.
- Pleural effusion occurred in 38.1% of the intervention group versus 80% in the control group.

## Abstract

Postoperative pulmonary complications (PPCs) following liver surgery are associated with considerable morbidity and mortality. Nevertheless, data regarding the effectiveness of short-term, self-conducted preoperative respiratory training on pulmonary function and its influence on postoperative recovery are limited.

Patients scheduled for liver surgery at the University Hospital Dresden, were screened for eligibility and randomized 1:1 to the intervention or control group. The intervention consisted of self-conducted respiratory training with an incentive spirometer for 14 consecutive days before surgery. Pulmonary function was assessed using longitudinal bodyplethysmography. The feasibility of the study design and clinical outcomes were evaluated.

Sixty-two patients were screened, 50 participants (81%) were randomized. Twenty control and 21 intervention participants (66.1%) completed all assessments and were included in the final analysis. Participants in the intervention group were highly compliant with the proposed inhalation training. Preoperative risk stratification for PPCs conducted according to the ARISCAT score revealed a high risk for PPCs in > 90% of all patients. Pneumonia occurred in 0 of intervention patients compared to 5 (25%) in the control group (p = 0.016). Pleural effusion was observed in 8 (38.1%) of intervention patients versus 16 (80%) in the control group (p = 0.007).

This pilot trial establishes the feasibility of a definitive randomized controlled trial to investigate the effect of short-term, self-conducted preoperative respiratory training on pulmonary function for the prevention of PPCs after hepatic resection.

The online version contains supplementary material available at 10.1007/s00423-025-03903-5.