Critical care requirements after elective surgery of the alimentary tract

Serious post-operative infectious complications requiring intensive care treatment were seen regularly in patients undergoing major abdominal surgery before peri-operative antimicrobial prophylaxis was introduced. A prospective multicentre study was carried out to study intensive care requirements in patients undergoing elective surgery of the alimentary tract in hospitals using a standardized antimicrobial prophylaxis regimen of a single intravenous dose of 400 mg doxycycline plus 1600 mg tinidazole 1-hour pre-operatively or at induction of anaesthesia. Only 56 (3.6%) out of the 1537 patients included in the study were treated in an intensive care unit for more than 1 day. Post-operative infectious complications related to peri-operative endogenous contamination were the reason for intensive care treatment in only 4 (0.26%) patients. It is concluded that such infectious complications are no longer the major reason for intensive care treatment after elective gastro-intestinal surgery and the substantial reduction in their frequency has been due to the use of 'short-term barrier' antimicrobial prophylaxis.