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Comment & Response
June 21, 2017

Incentive Spirometry After Bariatric SurgeryThe Importance of Patient Compliance

Author Affiliations
  • 1Department of Anesthesiology, University of Colorado School of Medicine, Aurora
  • 2Webb Waring Center, University of Colorado School of Medicine, Aurora
  • 3Department of Surgery, University of Colorado School of Medicine, Aurora
  • 4Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
JAMA Surg. Published online June 21, 2017. doi:10.1001/jamasurg.2017.1698

To the Editor We read with great interest the article by Pantel et al1 on the effect of routine incentive spirometry (IS) orders after bariatric surgery on patients with postoperative hypoxemia (defined as a peripheral saturation of oxygen level less than 92% without oxygen supplementation at 6, 12, and 24 hours after operation) and 30-day pulmonary complications. In this trial, 112 bariatric surgery patients were randomized to receive standard postoperative IS orders (including an IS device and a recommendation to use it 10 times every hour while awake) and 112 were randomized to no postoperative IS. Of note, postoperative IS was strictly an order set for nursing care, without any control over its implementation or patient performance. Interestingly, self-reported logs from 12 patients prior to the study showed a mean frequency of IS use of 4.1 times on postoperative day 1 and 10.4 times on day 2. This is an incredibly low compliance compared with the recommended 10 times per hour while awake.1 The authors acknowledge this limitation but only justify it as within the usual reported use range. Previous studies indicate that IS compliance is scarcely and inconsistently reported in clinical trials, which is essential to evaluate its effectiveness.2,3 Thus, the lack of significant benefit by IS in this study is not surprising and does not detract from the technique itself but rather its implementation.

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