**7. Infections**

Infectious complications after pulmonary surgery include operative wound infection, em‐ pyema, and nosocomial pneumonia. Antibiotic prophylaxis should therefore be guided against these three entities. The incidence varies from 5% to 24.4%. They are responsible for increased hospital mortality to up to 19% as well as increased costs and length of hos‐ pital stay. In one study 53.6% of the germs identified were gram-negative bacteria, 39.3% gram-positive bacteria, and 7.1% were fungi [137]. These infections should be aggressive‐ ly treated with appropriate antibiotics after culture. Chest physiotherapy, pain control, bronchodilators, and early ambulation should be done for all patients but regardless of these pneumonia develops. Postoperative atelectasis after pulmonary surgery should be aggressively managed before it deteriorates into pneumonia. Our policy is to give Ticar‐ cillin Sodium and Potassium Clavulanate 3.1 g four times a day in divided doses till a positive culture is obtained.

The incidence of empyema is dropping but could happen if there is prolonged air leak. Generally they are managed with antibiotics but may necessitate thoracotomy and wash out.

Other complications include pulmonary embolism, deep venous thrombosis, renal failure, strokes, major gastrointestinal bleed and late empyema. These complications should be recognised very early and aggressive management should be instituted if they are to be tackled successfully.

Thus postoperative care and management of postoperative complications is a team approach and good preoperative and intraoperative measures minimize the incidence of postoperative complications and early recognition and treatment is essential for successful outcomes.
