**1. Introduction**

Postoperative care of thoracic surgical patients is a very important part of patient recovery and can be very challenging. Pulmonary complications are responsible for significant numbers of deaths and morbidity of patients undergoing thoracotomy. Thoracic surgery impairs postop‐ erative respiratory function resulting in a relatively high risk of developing postoperative pulmonary complications. The incidence (19-59%) is much higher than following upper (16-17%) or lower abdominal surgery (0-5%). The overall incidence of complications following thoracic surgery varies from 15% to 37.5%, primarily due to the type of pulmonary complica‐ tions studied, the clinical criteria used in the definition and the type of surgery included. The clinical and potential economic impact of these complications is marked, with significantly longer hospital and high Dependency unit stay, frequency of ICU admission and number of deaths.

A centre can achieve excellent results by concentrating on the basics of postoperative care like pulmonary hygiene and physiotherapy, fluid and pain management and management of pleural spaces. Risk factors for complications following thoracic surgery have been identified from numerous clinical studies using a variety of research designs and definitions. The most frequent risk factors include age, preoperative pulmonary function tests, cardiovascular co morbidity, smoking status and chronic obstructive pulmonary disease (COPD). [1]- [4] In the current era there has to be more emphasis on postoperative care due to the complexity of referrals with the thoracic units doing more patients with multiple risk factors for post operative complications. This gets more challenging with cost containment.

High-risk patients can be optimised with preoperative and postoperative cardiopulmonary rehabilitation to reduce their operative risk, frequency of complications and hospital stay and improve postoperative outcomes including postoperative lung function. [5], [6] In addition,

© 2013 Iyer and Yadav; licensee InTech. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2013 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

preoperative pulmonary rehabilitation may improve preoperative exercise capacity and so operability. [7], [8] The future development and adoption of innovative strategies is required to reduce the impact of post operative complications in an ageing co morbid population.

been shown to reduce the incidence of these complications. During the work up assessment

Postoperative Care and Complications After Thoracic Surgery

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In the education session instructions may be given for deep breathing and splinted coughing exercises, prophylaxis exercises for deep vein thrombosis, and shoulder exercises [15]. There studies which question the benefit of preoperative education and physiotherapy and few studies have shown them to be non-beneficial16 but we continue to follow preoperative

Patients are also investigated for cardiac ailments if there are symptoms, signs or significant cardiac history prior to performing elective thoracic surgery. Investigations may include echocardiography, cardiac viability study or angiogram. Patients who are on antiplatelets should have their medications withheld 7 days prior to surgery is possible. If patients are on

Patients are given a single dose of antibiotics for elective cases and they are continued for infected cased or restarted postoperatively if needed. If surgical intervention is elective, we advocate a short period of preparation may be beneficial if directed at improving the patient's physical status and specifically at pulmonary preparation, conditioning exercises, and

Video assisted Thoracoscopic procedures are done with increasing frequency for many indications. The incidence of postoperative complications is 9% after VATS and they include haemorrhage, empyema, air leak, pneumonia and surgical emphysema [17] commonly but most of the complications which happen in thoracotomy could potentially happen with video

Most importantly the incidence of postoperative pain is much less in VATS than open procedures and they have shorter hospital stay. The proponents of VATS have published many series about the feasibility, lesser complication rate, reduced pain, early mobility and discharge [18], [19]. There are groups who did not find any statistical benefit in performing VATS and have quoted a higher bleeding and intraoperative complication rate [20]. In our unit we perform VATS for all kinds of thoracic procedures if patients are suitable for it. VATS lobec‐ tomy is a safe procedure, which reduces peri operative pain and improves postoperative physical status. The results obtained with early stage lung cancer are excellent and may reflect inherent oncologic advantageous consequent upon reduced operative trauma. Detection of early stage lung cancer is potentially rewarding and will become a practical imperative if survival results are to be improved. Thus the scope for VATS resection may increase signifi‐ cantly. In our view VATS lobectomy is the procedure of choice for early stage lung cancer and multicentre prospective randomised trials comparing this therapy against conventional open

warfarin then it is stopped 3 days prior to surgery and are covered with heparin

of the pulmonary functions are done and bronchodilators optimised.

education as well as physiotherapy prior to thoracic surgery.

nutrition.

**3. Operative factors**

assisted Thoracoscopic procedures.

**3.1. VATS vs. OPEN**

resection are overdue.

In this section will cover the routine care of a postoperative thoracic patient with specific emphasis on prevention and management of common complications.
