The diagnosis and prophylaxis of pulmonary complications of surgical operation

Eighty-eight non-bronchitic and 52 bronchitic patients undergoing elective general and plastic surgical operations in two wards were studied for postoperative chest complications, which were diagnosed by increased purulence of sputum and radiological changes at 24 or 48 hours. Eighty per cent of the patients undergoing upper abdominal surgery and 30 per cent of the other patients had chest complications. Postoperative bronchitis or pneumonia severe enough to delay discharge was found in 14 patients (10 per cent). Twice-daily physiotherapy to the chest did not affect the outcome in 86 patients without chronic bronchopulmonary disease. Routine administration of ampicillin to ‘cover’ chronic bronchitics undergoing general anaesthesia was found to be of no value in a controlled trial of the 52 bronchitic patients. However, bacteriological and radiological studies lend some support to the suggestion that prophylaxis with a bactericidal antibiotic may reduce the incidence and morbidity of postoperative pulmonary infections in patients having upper abdominal operations.