An Exploratory and Qualitative Analysis of Self-Reported Evaluations for Fever

Area of Science:

• Infectious Diseases
• Surgical Outcomes
• Clinical Practice Guidelines

Background:

• Post-operative fever is common, yet evaluation and management lack standardized approaches.
• Variability exists in deciding when to evaluate fever and initiate empiric antibiotic therapy.
• Lack of consensus impacts patient care and resource utilization.

Purpose of the Study:

• To survey Surgical Infection Society members on current practices for evaluating post-operative fever.
• To identify areas of consensus and equipoise in fever work-up and management.
• To inform the development of evidence-based guidelines for post-operative fever evaluation.

Main Methods:

• Survey of Surgical Infection Society membership using eight clinical scenarios for febrile post-operative patients.
• Inclusion of 19 work-up components (e.g., CBC, imaging, biomarkers) and management options (antibiotics).
• Scenarios were re-evaluated for intensive care unit (ICU) patients; consensus defined as agreement by <1/4 or >3/4 of respondents.

Main Results:

• Only complete blood count (CBC) and physical examination achieved broad consensus.
• Blood/urine cultures, imaging, lactate, procalcitonin (PCT), and empiric antibiotics lacked consensus.
• Fever threshold, duration, clinical suspicion, and physiologic manifestation were key qualitative decision factors.

Conclusions:

• Consensus exists only for basic evaluations (physical exam, routine labs) in febrile post-operative patients.
• Significant variability in diagnostic and therapeutic choices highlights a need for standardized protocols.
• Areas of equipoise are prime candidates for formal clinical guidance and future research.