Early postoperative fever and the "routine" fever work-up: results of a prospective study

Fever in the postoperative period frequently results in a battery of diagnostic tests in search of an etiology. We sought to evaluate the incidence and utility of extensive postoperative fever evaluations in a teaching hospital setting.

Prospective observational study of all adult patients undergoing in-patient general surgical procedures during a 13-mo period. Patients experiencing an early postoperative fever (>100.4° F in the first 72 h) had data collected on their evaluation, the yield of the diagnostic studies, and whether an infectious diagnosis was made.

Of 1032 surgical procedures, 245 (23.7%) patients experienced an early postoperative fever. One hundred patients (9.7%) underwent documented fever evaluation. Thirty-five (35%) had blood cultures with no positive results among elective surgery patients. Forty-six patients (46%) had urine cultures sent, of which four infections were diagnosed (8.9%). Fifty chest radiographs were performed, but the diagnosis of pneumonia was made by only three (6.0%). Ultimately, 18 febrile patients (18%) were diagnosed with an infectious source, in nine of these patients the physical exam and clinical picture accurately diagnosed the infection without need for further testing.

Early postoperative fever is a common event and rarely caused by an infection. A brief bedside evaluation has the highest yield for determining the fever etiology, and extensive evaluations with cultures and chest imaging have little to no benefit in patients admitted for elective surgery.