52-year-old man is found to be tachypneic 2 days after an uncomplicated upper abdominal ventral hernia repair. Until now, his postoperative course had been unremarkable, and he has low-dose morphine for pain control. The patient feels SOB but has no chest pain. He has an occasional cough with a small amount of early-morning sputum. The patient is an active smoker with a 15-pack-year history. Temp is 36.7C (98.1F), BP is 123/79, HR is 90/min and RR are 28/min. BMI is 32kg/m2. There are decreased breath sounds at the right lung base without wheezes or prolonged expiration. Heart sounds are normal. There is abdominal distension & diffuse tenderness without rebound. CXR reveals a dense opacity at the right lung base. Which of the following would have been most effective in preventing this patient's current condition?
A. Perioperative broad-spectrum ABX
B. Postoperative deep-breathing exercises
C. Postoperative low-molecular-weight Heparin
D. Preoperative systemic glucocorticoids & albuterol
E. Smoking cessation 1 week before surgery
