Conservative management of isolated posthysterectomy fever

To demonstrate that an isolated fever in the absence of other signs or symptoms of infection following hysterectomy does not require empiric antibiotics and laboratory tests.

Retrospective analysis of all the charts of patients who had a hysterectomy from July 1995 to December 1996 at our institution. Patients with a postoperative temperature > 38 degrees C had a physical examination. If the examination was normal, no studies were ordered, and antibiotic therapy was not initiated. If a patient was febrile after 72 hours postoperatively, laboratory studies and radiographic tests were ordered. If the results were negative, the patient did not appear septic, and physical examination was normal, no antibiotics were given. Outcomes were measured by comparing patients with postoperative infections and fever to those without infections.

Of 132 patients, 112 were included in the study. Seventy-two hysterectomies were abdominal and 40 vaginal. Postoperative fever during the first 72 hours following hysterectomy occurred in 51/112 (46%) patients. Clinically significant infection was documented in seven patients, all of whom manifested signs and symptoms of infection > 72 hours postoperatively.

Postoperative fever in the first 72 hours after hysterectomy is common and nonspecific. If a febrile patient does not show any other signs or symptoms of infection, it is safe to forego routine laboratory and imaging studies as well as therapeutic antibiotics.