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Yield of postoperative fever evaluation.
1Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Medical College of Ohio, Ohio, Toledo, USA
Primary Care Update for Ob/Gyns
|June 6, 2000
Summary
Postoperative fever evaluation in gynecologic surgery patients rarely yields positive results from blood cultures, urine cultures, or chest x-rays. These tests are infrequently positive, suggesting a need to re-evaluate their routine use.
Area of Science:
- Gynecology
- Infectious Disease
- Medical Diagnostics
Background:
- Postoperative fever is common in women undergoing major gynecologic surgery.
- Current evaluation protocols often include blood cultures, urine cultures, and chest x-rays.
Purpose of the Study:
- To determine the frequency and diagnostic yield of blood cultures, urine cultures, and chest x-rays in evaluating postoperative fever.
- To identify predictors for positive results and specific conditions like pneumonia.
Main Methods:
- Retrospective review of 537 patients undergoing major gynecologic surgery.
- Analysis of fever evaluation methods (blood cultures, urine cultures, chest x-rays) in 211 febrile patients.
- Logistic regression to identify predictors of positive cultures and pneumonia.
Main Results:
- 39% of patients developed postoperative fever (>38°C).
- Blood cultures (37%), urine cultures (50%), and chest x-rays (26%) were performed in febrile patients.
- Positive results were rare: 0% for blood cultures, 10% for urine cultures, and 9% for chest x-rays. Late fever predicted positive urine cultures; early fever and age predicted pneumonia.
Conclusions:
- Routine blood cultures, urine cultures, and chest x-rays have a low yield in evaluating postoperative fever after gynecologic surgery.
- Fever evaluation strategies may need refinement, considering predictors like fever onset and patient age.
- Pneumonia, often symptomatic, was identified in a subset of patients, highlighting the importance of clinical assessment.