Spirometer vs. Deep Breathing: Lung Complications About 1% Either Way

Incentive spirometry has long been a standard post-op nursing intervention. A new analysis in the American Journal of Nursing reviewed 2,386 adult surgical encounters and found pulmonary complications in only about 1%, with no significant difference by respiratory order. A gap in readmissions appeared, then did not hold up. The signal that may matter more at the bedside involved a different order entirely: physical therapy.

What happened

The paper, by Lorrie Jones and colleagues, was published online ahead of print on Oct. 28, 2026. The authors are clinical nurse specialists and a research biostatistician at Mayo Clinic Hospital in Phoenix. The full text is paywalled, so everything here about the study comes from its published abstract.

The team retrospectively analyzed electronic health record data from adult inpatient surgical encounters at a tertiary academic medical center, covering July to December 2019 and July to December 2022. Their aim was to compare coughing and deep breathing alone against combined coughing, deep breathing and incentive spirometry for preventing postoperative pulmonary complications and 30-day readmissions in postsurgical patients without underlying pulmonary disease. Spirometry alone served as an additional comparator.

• Incentive spirometry alone: 508 encounters (21.3%)
• Coughing and deep breathing alone: 1,127 encounters (47.2%)
• Both combined: 751 encounters (31.5%)

• Pulmonary complications: about 1% of encounters, with no significant differences between groups.
• Readmissions: after adjustment, coughing and deep breathing alone carried higher odds of 30-day readmission than spirometry alone (odds ratio 1.28; 95% CI, 1.02-1.60; P = 0.03). The combined group did not differ significantly from spirometry alone.
• The catch: the authors report that this readmission association was not sustained in sensitivity analyses.
• Other predictors: longer length of stay and absence of physical therapy orders were independently associated with higher readmission risk.

The authors conclude that the findings support continued spirometry use with “a multimodal postoperative care approach emphasizing early mobility and PT.”

What this study cannot tell you

• Cause and effect. This is an observational, retrospective design. The model adjusted for surgery type and duration, ASA physical status, physical therapy orders, Bedside Mobility Assessment Tool scores and prior pulmonary-related diagnoses, but it shows associations only.
• Whether patients did the exercises. The abstract reports what was prescribed. It gives no data on whether or how well each patient performed them.
• Why patients came back. The abstract gives neither readmission rates nor reasons, so it does not show that these readmissions were respiratory.
• How far it applies. The abstract describes one medical center and an aim focused on patients without underlying pulmonary disease.

One more point is our reading, not a limitation the abstract states. About 1% of 2,386 is roughly two dozen events, and an outcome that rare gives any comparison less ability to detect a real difference. So “no significant difference” does not prove the interventions are equivalent.

Why it matters at the bedside

The abstract itself notes that studies of spirometry alone have reported mixed results. The American Association for Respiratory Care reached a similar place in its 2011 guideline: spirometry alone is not recommended for routine use to prevent postoperative pulmonary complications, but it is recommended alongside deep breathing, directed coughing, early mobilization and optimal analgesia. The guideline also suggests that deep breathing exercises provide the same benefit as spirometry.

The new paper does not settle that debate, and the physical therapy finding needs the same caution as the rest. Patients without a physical therapy order may differ in ways the data did not capture, so this does not prove that a therapy order prevents readmission. Still, it fits a familiar message: a respiratory order alone is not the whole plan.

Technique counts too. The AARC guideline says spirometry is ineffective unless performed as instructed, and calls intermittent reassessment essential. It lists patients who are confused, delirious or heavily sedated, and those unable to deep breathe effectively because of pain, among those for whom spirometry is contraindicated. Listed hazards include hyperventilation, fatigue, pain, and hypoxemia from interrupting prescribed oxygen.

What it means for nursing students and the NCLEX

One retrospective study does not change the fundamentals. Keep learning the teaching. For the spirometer, AARC describes this sequence: hold the device upright, exhale normally, seal the lips around the mouthpiece, inhale slowly to the set target, then hold the breath and exhale normally. AARC describes sustaining the breath for at least 5 seconds, while MedlinePlus patient instructions say 3 to 5. MedlinePlus advises 10 to 15 breaths every 1 to 2 hours or as the provider instructs, and AARC notes that evidence for a specific frequency is lacking. For a chest or abdominal incision, MedlinePlus advises holding a pillow firmly over it.

This paper is also a good lesson in reading research:

• Odds are not rates. An odds ratio of 1.28 means 28% higher odds, not 28% more readmissions. Without the underlying rates, you cannot convert it.
• Look at the interval. An odds ratio of 1 means no difference, and this interval starts at 1.02, barely above that line.
• Check for stability. A sensitivity analysis tests whether a result holds when the analysis is run differently. A finding that fades is a reason for caution, even with P = 0.03.

What to do now

• Follow your unit’s protocol and the provider order. This study is not a reason to drop or substitute an ordered intervention.
• Teach, then watch a return demonstration. Recheck technique and keep the device within reach.
• Treat breathing, pain and movement as one plan. Pain that limits a deep breath deserves attention.
• Speak up about mobility. If a patient is struggling to get moving and has no physical therapy order, raise it with the team.
• Keep assessing. Track respiratory rate, breath sounds, oxygen saturation and temperature, and report changes per your protocol.