Postoperative Fever


Immediate (within hours)

Acute (within the first week)

Subacute (1–4 weeks out)

Trauma/cytokine release

Surgical site infection (after 48 h)

Surgical site infection

Medications, including malignant hyperthermia

Pneumonia

Thrombophlebitis/DVT/PE

Transfusion reaction

UTI

C. difficile

Necrotizing fasciitis

IV catheter infection

Drug reactiona

Infection, thrombosis, or other noninfectious causes present prior to surgery

Noninfectious: MI, DVT/PE, CVA/SAH, thrombophlebitis, hematoma, pancreatitis, alcohol withdrawal, gout, bowel ischemia, TTP, hyperthyroidism, adrenal insufficiency, transfusion or medication reaction, inflammatory reaction to implanted hardware, etc.

Nosocomial or other infections: pneumonia, UTI, IV catheter-related infection, intra-abdominal abscess, sinusitis, otitis media, osteomyelitis, endocarditis, cholecystitis (can be acalculous), etc.b [Neoplasia and collagen-vascular diseases are less common causes of postoperative fever]


aCommonly implicated medications: beta-lactams, sulfa, phenytoin, heparin, etc. [6]

bWatch for surgery-specific causes: i.e., meningitis after neurosurgery, toxic shock after nasal or vaginal packing, parotitis after oral surgery, rejection after transplant surgery, fat emboli after orthopedic surgery, infected hardware or graft material, etc.



Cultures have little utility in the first 48 h after surgery, unless there is suspicion for antecedent infection. Fever occurring after postoperative day 3, multiple days of fever, and maximum temperature of greater than or equal to 39C are predictors of a positive fever evaluation [7]. A brief bedside evaluation has the highest yield for determining the etiology of a fever [8]. After 72 h, consider ordering the following tests, using the bedside evaluation and the clinical context as a guide [1, 6]:

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Oct 6, 2016 | Posted by in RESPIRATORY | Comments Off on Postoperative Fever

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