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Fever evaluations after colorectal surgery: identification of risk factors that increase yield and decrease cost.

A da Luz Moreira1, J D Vogel, M F Kalady

  • 1Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Avenue, A30-262, Cleveland, Ohio 44195, USA.

Diseases of the Colon and Rectum
|January 30, 2008
PubMed
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Fever evaluations after colorectal surgery are often low yield and costly. Identifying risk factors like high fever or late symptoms can help target these investigations more effectively.

Area of Science:

  • Colorectal Surgery
  • Postoperative Care
  • Infectious Disease Evaluation

Background:

  • Postoperative fever is common after elective colorectal surgery.
  • Fever evaluations are standard but their diagnostic yield and cost-effectiveness are debated.

Purpose of the Study:

  • To evaluate the diagnostic yield and cost of fever evaluations in average-risk inpatients following elective colorectal surgery.
  • To identify predictors of a positive fever evaluation.

Main Methods:

  • Retrospective study of 133 patients with postoperative fever (≥38°C) after elective colorectal surgery.
  • Defined positive evaluation by culture or imaging results altering patient management.
  • Used logistic regression and chi-squared tests to identify risk factors and calculate costs.

Related Experiment Videos

Main Results:

  • Only 26% of fever evaluations were positive, with CT scans being the most frequent positive diagnostic test (46%).
  • Risk factors for positive evaluation included higher fever (≥38.5°C), late evaluation (postoperative Day 6+), and systemic inflammatory response syndrome.
  • Cost per positive evaluation varied significantly, from $5,600 overall to $2,140 for patients with three risk factors.

Conclusions:

  • Current fever evaluation protocols after colorectal surgery are low-yield and expensive.
  • High fever, late-onset fever, and SIRS are key indicators for a positive fever evaluation, suggesting targeted approaches may be more efficient.