Non-drug perioperative interventions to reduce postoperative pulmonary complications after abdominal surgery: systematic review and meta-analysis.

Summary

This comprehensive meta-analysis of 255 RCTs (55,260 participants) synthesizes 10 classes (39 subtypes) of non-drug perioperative interventions to prevent postoperative pulmonary complications after abdominal surgery. PPCs occurred in 11.7% overall, and the authors used trial sequential analysis and GRADE to prioritize strategies and establish an evidence hierarchy, including oxygen fraction strategies among high-certainty domains.

Key Findings

• Synthesized 255 RCTs (55,260 participants) evaluating 10 intervention types and 39 subtypes for PPC prevention in abdominal surgery.
• Overall PPC incidence across trials was 11.7%, enabling benchmarking for future studies and quality initiatives.
• Used trial sequential analysis and GRADE to establish an evidence hierarchy; oxygen fraction strategies were among high-certainty domains.

Clinical Implications

Supports prioritization of selected perioperative systems and respiratory care strategies to reduce PPC risk after abdominal surgery and guides protocol standardization with GRADE-based certainty.

Limitations

• Heterogeneity in PPC definitions and timepoints across RCTs
• Intervention diversity may limit direct comparability and meta-analytic precision for some subgroups

Future Directions

Head-to-head pragmatic trials and implementation studies are needed to operationalize top-ranked strategies within ERAS bundles and validate impact on PPCs, LOS, and cost.