Postoperative chest infection after upper abdominal surgery: an important problem for smokers.

The incidence and risk factors for postoperative chest infection have been studied in 127 patients undergoing elective upper abdominal surgery. The overall incidence of postoperative chest infection was 20.5%. Mean length of postoperative stay was extended from 7.8 to 10.7 days in those developing infection (P less than 0.05). Patients who smoked cigarettes and those with smoking related diseases had a considerably higher risk of infection. Patients with chronic bronchitis and airflow obstruction had an incidence of infection of 85.7%, those with chronic bronchitis alone 83.3% and those with airflow obstruction and no chronic bronchitis 50%. Patients with a smoking history of greater than or equal to 20 pack years but no chronic bronchitis or airflow obstruction had an incidence of 20.8%. All three were independently significant risk factors for infection. Patients without respiratory disease and who were non-smokers had an incidence of infection of only 7.1%. Smoking and its sequelae are the principal risk factors for postoperative chest infection. This study shows that the high risk patient can readily be identified by enquiry into respiratory symptoms, smoking history and by spirometry. This is the group in whom prophylactic measures are especially important, and they require close supervision to enable early identification and therapy of infection.