Introduction: While some reports have described the use of incentive spirometry (IS) beginning a few days prior to cardiac surgery, there is a lack of studies investigating its implementation from an earlier preoperative period. Furthermore, the relationship between the duration of preoperative IS use and the incidence of postoperative pulmonary complications (PPCs) remains unclear. Therefore, this study aimed to clarify the impact of different durations of preoperative IS use on postoperative outcomes, particularly the incidence of PPCs. Methods: A total of 91 patients who underwent elective cardiac surgery at our institution were included. Preoperative IS instruction was provided, and the duration from the initiation of IS to the day of surgery was recorded. Patients were divided into two groups: the short-term IS group (≤14 days, n=17) and the long-term IS group (≥15 days, n=74). Postoperative outcomes and the incidence of PPCs were compared between the two groups. Results: Compared to the short-term IS group (n=17), the long-term IS group (n=74) had a significantly lower incidence of postoperative pulmonary complications (47.0% vs. 17.5%, p<0.05), and fewer days to achieve sitting (3 vs. 2 days), standing (4 vs. 4 days), and walking (6 vs. 4 days) (p<0.05). Additionally, the long-term group showed significantly better outcomes at discharge in terms of physical function (SPPB: 9 vs. 12), functional status (FSS-ICU: 33 vs. 35, p<0.01), and discharge disposition (transfer to another hospital: 35.2% vs. 9.4%, p<0.05). Conclusion: Initiating IS instruction more than two weeks prior to cardiac surgery may reduce the incidence of postoperative pulmonary complications and contribute to earlier mobilization and better postoperative physical function.

Objective: In 2016, Japan started conducting musculoskeletal examinations that included “limb status” of students as an essential item. Our institution implemented a unified musculoskeletal examination for all public elementary and junior high schools in T-city. In this study, we aimed to report the progress in the past 4 years.Patients and Methods: The Tsukuba Childhood Locomotive-Organ Screening Sheet (T-CLOSS), which is a questionnaire that includes some nationwide-recommended questions, was prepared and distributed to students. Results of the questionnaires were analyzed, and the orthopedic surgeon conducted examinations for the extracted items. From these questionnaires, the ratio of each item, rate of advisory for screening, and content of the advisory were investigated.Results: During 2016–2019, musculoskeletal examinations were conducted in every public schools, with nearly 20,000 students in T-city. The consultation advisory rate was 6.7% in 2019. Of the 524 students who received the third screening recommendation, the actual consultation rate was 248 (40.8%). After the third screening, the proportion of students requiring treatment and outpatient visits was 46.7% (n=248), which accounted for 1.2% of all elementary and junior high school students in the city.Conclusion: We reported the results of 4-year musculoskeletal examinations in a city. In our screening, we distributed a uniform questionnaire throughout the city, and orthopedic surgeons performed secondary examinations of identified students in all schools. This appears to be an advanced effort to prevent musculoskeletal impairment in students. We hope to conduct more sophisticated musculoskeletal examinations using our results, aiming at early detection, early treatment, and improvement of musculoskeletal function in elementary and junior high school students.