POSTOPERATIVE FEVER

Hamad Emad Hamad Dhuhayr

Contents

Define

Pathophysiology

Causes

Treatment

Define

Pyrexia is a common feature of postoperative infections,

although it may be absent in immunologically compromised patients.

Its important features are:

• time of onset;

• degree of pyrexia and type (persistent, intermittent);

• accompaniments, particularly rigors (shivering) and haemodynamic change.

In the first 24 hours after an operation, 27-58% of patients may develop fever.

Pathophysiology

Fever >38ºC is common after surgery

Usually inflammatory stimulus of surgery and resolves spontaneously

Fever = response to cytokine release Fever-associated cytokines are released by tissue

trauma and do not necessarily signal infection. Cytokines produced by monocyte, macrophages,

endothelial cells. Fever-associated cytokines = IL-1, IL-6, TNF-alpha,

IFN-gamma.

What are the commoncauses?

1. Wind Atelectasis, pneumonia

2. Water UTI, anastomotic leak

3. Wound Wound infection, abscess

4. Walking DVT / PE

5. Wonder-drug

Evaluation

ABCs

Resuscitate

History of Present Illness : anesthesia record, operative note, nursing report, flowchart

PE: Complete exam Look at wounds - take off dressings Look at drain output Check peripheral intravenous line sites,

Central venous line, Foley, tubes

Labs/Studies

Labs to order if concerned for infection: CBC, sputum Cx, UCx, Blood Cx x2

Imaging: CXR (for pneumonia) Lower extremity venous duplex (for DVT) CT scan (for abscess, leak, pancreatitis,

PE)

Management

Intervention needed?

Remove/replace sources of infection Foley catheter, central lines, or peripheral IV’s Open, debride, and drain infected wounds

If suspect pneumonia, bacteremia, UTI, sepsis – start broad spectrum antibiotics

Anticoagulation for DVT/PE

CT guided drainage of abscess

Take-home message

Fever can appear for both infectious and non-infectious reasons after an operation.

In the first 24 hours after operation, 27% to 58% of patients may develop fever.

Physical examination should include the respiratory, cardiovascular, urinary, and gastrointestinal systems, as well as an examination of the skin.

Thrombophlebitis can often be treated with warm compresses and anti-inflammatory agents.

References

Bailey & love’s

Clinical Surgery SECOND EDITION

The Canadian Journal of CME / May 2004