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Internal Medicine

Postoperative fever

Temperature ≥ 38ºC/100.4ºF on 2 consecutive postoperative days or > 39ºC/102.2ºF on any postoperative day.

  • Incidence: 20-90% depending on type of surgery and other factors
  • Occurs after all types of surgical procedures, irrespective of the type of anaesthesia.

Aetiology

The classic “Ws” of postoperative fever:

  • Postoperative day 1-2: Wind: Atelectasis
  • Postoperative day 2-3: Water: Urinary tract infection (UTI)
  • Postoperative day 3-7: Wound: Wound infection
  • Postoperative day 5-7: Walking: Deep venous thrombosis (DVT)/thrombophlebitis
  • Postoperative day >7: Wonder drug: drug fever [Asgar Pour, 2012

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Pathophysiology

Complications

  • Undiagnosed infection: Sepsis and even death
  • Prolonged hospitalization (more chance of infection)

Diagnosis

F1.medium
Number of positive diagnostic test performed for the assessment of postoperative fever in comparison to the positive ones | Disseminated intravascular coagulation. (2016). Nature Reviews Disease Primers, 2, 16038. Retrieved from http://dx.doi.org/10.1038/nrdp.2016.38

Management

strategies-in-patients-with-postoperative-fever
Strategies in patients with postoperative fever. | Fever Evaluation, Complication and Treatment in Surgical Patients – Scientific Figure on ResearchGate. Available from: https://www.researchgate.net/figure/Strategies-in-patients-with-postoperative-fever_fig1_299750165 [accessed 14 Jul, 2019]

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