interdiscip med j Interdisciplinary Medical Journal 2980-1915 Hatay Mustafa Kemal University 10.17944/interdiscip.1804135 Thoracic Surgery Cardiovascular Surgery Göğüs Cerrahisi Kalp ve Damar Cerrahisi The effects of sternotomy and thoracotomy on respiratory muscle strength https://orcid.org/0000-0003-4526-4280 Öztekin Özerk BALIKESİR ÜNİVERSİTESİ, SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ (HASTANESİ), CERRAHİ TIP BİLİMLERİ BÖLÜMÜ, ANESTEZİ VE REANİMASYON ANABİLİM DALI https://orcid.org/0000-0002-5417-2217 Hepağuşlar Hasan DOKUZ EYLUL UNIVERSITY, SCHOOL OF MEDICINE, DEPARTMENT OF SURGICAL MEDICAL SCIENCES, DEPARTMENT OF ANESTHESIOLOGY AND REANIMATION https://orcid.org/0000-0003-0352-7644 Girgin A. Pelin IZMIR BAKIRCAY UNIVERSITY, SCHOOL OF MEDICINE https://orcid.org/0000-0002-9082-8631 Albayrak Gökhan İZMİR EKONOMİ ÜNİVERSİTESİ, TIP FAKÜLTESİ https://orcid.org/0000-0002-3383-4832 Ulugün İlknur DOKUZ EYLUL UNIVERSITY, SCHOOL OF MEDICINE https://orcid.org/0000-0003-3086-8284 Özdemir Nezih DOKUZ EYLUL UNIVERSITY, SCHOOL OF MEDICINE https://orcid.org/0000-0003-0200-8439 Çımrın A. Hikmet DOKUZ EYLÜL ÜNİVERSİTESİ, TIP FAKÜLTESİ https://orcid.org/0009-0004-4211-5882 Hazan Eyüp İZMİR EKONOMİ ÜNİVERSİTESİ Elar Zahide DOKUZ EYLÜL ÜNİVERSİTESİ, TIP FAKÜLTESİ, CERRAHİ TIP BİLİMLERİ BÖLÜMÜ, ANESTEZİYOLOJİ VE REANİMASYON ANABİLİM DALI 04 16 2026 17 57 66 72 10 20 2025 03 02 2026 Copyright © 2023, Interdisciplinary Medical Journal 2023 Interdisciplinary Medical Journal

Objective: The aim of this prospective clinical study was to investigate the effects of sternotomy and thoracotomy on respiratory muscle strength (RMS). Method: After obtaining ethics committee approval and written informed consent from patients, 60 patients who underwent open heart surgery using sternotomy (Sternotomy Group [SG], n=30) or lung surgery using thoracotomy (Thoracotomy Group [TG], n=30) were included. Pulmonary function test (PFT) and respiratory muscle strength (RMS) test were performed before and after surgery to compare forced expiratory volume during the first second of the breath (FEV1), forced vital capacity (FVC), maximal inspiratory pressure (Pİmax), maximal expiratory pressure (PEmax), and sniff nasal inspiratory pressure (SNIP) between groups. Results: Preoperative FEV1, FVC, Pİmax, PEmax, and SNIP were similar between groups (p>0.05) and were found to be decreased significantly in the postoperative period (p

 Respiratory function tests anesthesia general sternotomy thoracotomy None Ragnarsdóttir M, KristjAnsdóttir A, Ingvarsdóttir I, Hannesson P, Torfason B, Cahalin L. Short-term changes in pulmonary function and respiratory movements after cardiac surgery via median sternotomy. Scand Cardiovasc J. 2004;38(1):46-52. doi: 10.1080/14017430310016658. PMID: 15204247. Bauer C, Hentz JG, Ducrocq X, Meyer N, Oswald-Mammosser M, Steib A, Dupeyron JP. Lung function after lobectomy: a randomized, double-blinded trial comparing thoracic epidural ropivacaine/sufentanil and intravenous morphine for patient-controlled analgesia. Anesth Analg. 2007;105(1):238-44. doi: 10.1213/01.ane.0000266441.58308.42. Varela G, Brunelli A, Rocco G, Novoa N, Refai M, Jiménez MF, Salati M, Gatani T. Measured FEV1 in the first postoperative day, and not ppoFEV1, is the best predictor of cardio-respiratory morbidity after lung resection. Eur J Cardiothorac Surg. 2007;31(3):518-21. doi: 10.1016/j.ejcts.2006.11.036. Endoh H, Tanaka S, Yajima T, Ito T, Tajima K, Mogi A, Shitara Y, Kuwano H. Pulmonary function after pulmonary resection by posterior thoracotomy, anterior thoracotomy or video-assisted surgery. Eur J Cardiothorac Surg. 2010;37(5):1209-14. doi: 10.1016/j.ejcts.2009.11.016. Kabitz HJ, Walterspacher S, Walker D, Windisch W. Inspiratory muscle strength in chronic obstructive pulmonary disease depending on disease severity. Clin Sci (Lond). 2007;113(5):243-9. doi: 10.1042/CS20060362. PMID: 17391105. Stein R, Maia CP, Silveira AD, Chiappa GR, Myers J, Ribeiro JP. Inspiratory muscle strength as a determinant of functional capacity early after coronary artery bypass graft surgery. Arch Phys Med Rehabil. 2009;90(10):1685-91. doi: 10.1016/j.apmr.2009.05.010. Bernard A, Brondel L, Arnal E, Favre JP. Evaluation of respiratory muscle strength by randomized controlled trial comparing thoracoscopy, transaxillary thoracotomy, and posterolateral thoracotomy for lung biopsy. Eur J Cardiothorac Surg. 2006;29(4):596-600. doi: 10.1016/j.ejcts.2005.12.041. Berrizbeitia LD, Tessler S, Jacobowitz IJ, Kaplan P, Budzilowicz L, Cunningham JN. Effect of sternotomy and coronary bypass surgery on postoperative pulmonary mechanics. Comparison of internal mammary and saphenous vein bypass grafts. Chest. 1989;96(4):873-6. doi: 10.1378/chest.96.4.873. Weiner P, Zeidan F, Zamir D, Pelled B, Waizman J, Beckerman M, Weiner M. Prophylactic inspiratory muscle training in patients undergoing coronary artery bypass graft. World J Surg. 1998;22(5):427-31. doi: 10.1007/s002689900410. Bastin R, Moraine JJ, Bardocsky G, Kahn RJ, Mélot C. Incentive spirometry performance. A reliable indicator of pulmonary function in the early postoperative period after lobectomy? Chest. 1997;111(3):559-63. doi: 10.1378/chest.111.3.559. Steier J, Kaul S, Seymour J, Jolley C, Rafferty G, Man W, Luo YM, Roughton M, Polkey MI, Moxham J. The value of multiple tests of respiratory muscle strength. Thorax. 2007;62(11):975-80. doi: 10.1136/thx.2006.072884. Tenling A, Joachimsson P-O, Tydén H, Hedenstierna G. Thoracic epidural analgesia as an adjunct to general anaesthesia for cardiac surgery. Effects on pulmonary mechanics. Acta Anaesthesiol Scand. 2000;44(9):1071-6. doi: 10.1034/j.1399-6576.2000.440906.x. Pastor J, Morales P, Cases E, Cordero P, Piqueras A, Galán G, París F. Evaluation of intercostal cryoanalgesia versus conventional analgesia in postthoracotomy pain. Respiration. 1996;63(4):241-5. doi: 10.1159/000196553. PMID: 8815972. Kocjan J, Rydel M, Czyżewski D, Adamek M. Comparison of Early Postoperative Diaphragm Muscle Function after Lobectomy via VATS and Open Thoracotomy: A Sonographic Study. Life (Basel). 2024 9;14(4):487. doi: 10.3390/life14040487. Sirakaya F, Calik Kutukcu E, Onur MR, Dikmen E, Kumbasar U, Uysal S, Dogan R. The Effects of Various Approaches to Lobectomies on Respiratory Muscle Strength, Diaphragm Thickness, and Exercise Capacity in Lung Cancer. Ann Surg Oncol. 2024;31(9):5738-5747. doi: 10.1245/s10434-024-15312-x. Cursino de Moura JF, Oliveira CB, Figueira APC, Elkins MR, Pacagnelli FL. Preoperative respiratory muscle training reduces the risk of pulmonary complications and the length of hospital stay after cardiac surgery: a systematic review. J Physiother. 2024;70:16–24. doi:10.1016/j.jphys.2023.10.012. Somers T, Iskander S, Verhagen AFTM, Li WWL. Diaphragm Dysfunction After Cardiac Surgery. Braz J Cardiovasc Surg. 2025;40(4):e20230239. doi:10.21470/1678-9741-2023-0239. Huai H, Ge M, Zhao Z, Xiong P, Hong W, Jiang Z, Wang J. Early diaphragm dysfunction assessed by ultrasonography after cardiac surgery: a retrospective cohort study. Front Cardiovasc Med. 2024;11:1457412. doi: 10.3389/fcvm.2024.1457412. Wang Q, Tao Y, Zhang X, Xu S, Peng Y, Lin L, Chen L, Lin Y. The Incidence, Risk Factors, and Hospital Mortality of Prolonged Mechanical Ventilation among Cardiac Surgery Patients: A Systematic Review and Meta-Analysis. Rev Cardiovasc Med. 2024 20;25(11):409. doi: 10.31083/j.rcm2511409. Kumalasari RI, Kosasih CE, Priambodo AP. Risk Factors of Prolonged Mechanical Ventilation in Post Coronary Artery Bypass Graft Patients: A Scoping Review. J Multidiscip Healthc. 2025;18:903-915 https://doi.org/10.2147/JMDH.S483973.