Fever Evaluations after Colorectal Surgery: Identification of Risk Factors that Increase Yield and Decrease Cost

Moreira, André da Luz; Vogel, Jon D.; Kalady, Matthew F.; Hammel, Jeffrey; Fazio, Victor W.

doi:10.1007/s10350-007-9183-2

Cited by 16 publications

(5 citation statements)

References 13 publications

(31 reference statements)

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“…Theuer and colleagues [16] evaluated 108 sets of blood cultures from 72 febrile patients, and found five positive results, but none of them in patients febrile during the first 72 h postop. In the other studies described previously, blood cultures were positive 0%-5% of the time, and only one study [6] reported a positive blood culture in a patient febrile during the first 3 d postop. This is in agreement with our results of no events of bacteremia diagnosed by blood cultures.…”

Section: Discussionmentioning

confidence: 86%

“…In the largest series of postoperative fever evaluations, da Luz Moreira and colleagues [6] retrospectively looked at 133 fever evaluations which occurred among 1769 colorectal and small bowel procedures. They reported that only 16% of patients who developed fever from 0 to 2 d after surgery received a diagnosis of infection, compared with 46% of febrile patients past postoperative d 6.…”

Section: Discussionmentioning

confidence: 99%

“…Although some evidence exists for the benign and non-infectious nature of early post-operative fever [4,5], it is our experience that extensive and often reflexive ''fever work-ups'' are frequently performed to exclude infectious etiology. Chest radiographs, blood and urine cultures, and other laboratory studies are often ordered without regard to the clinical picture, despite being shown previously to have low yield in the immediate postoperative period [1,6,7]. The evaluation of the febrile patient in these circumstances seems directed more by tradition and anecdotal experience than by evidence.…”

Section: Introductionmentioning

confidence: 96%

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Early Postoperative Fever and the “Routine” Fever Work-Up: Results of a Prospective Study

Lesperance

Lehman

Lesperance

et al. 2011

Journal of Surgical Research

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

See 1 more Smart Citation

Early Postoperative Fever and the “Routine” Fever Work-Up: Results of a Prospective Study

Lesperance

Lehman

Lesperance

et al. 2011

Journal of Surgical Research

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“…Prior studies of knee, spine, and general surgery procedures have reported that fevers after POD 2, lasting longer than 24 hours, peaking above 38.9˚C, or multiple fever spikes may all be more a sign of an infectious complication [4,37,[51][52][53][54]. There were few studies on the relationship between fever, infection, and other postoperative outcomes in patients who undergo PLOS ONE liver surgery.…”

Section: Plos Onementioning

confidence: 99%

Postoperative fever after liver resection: Incidence, risk factors, and characteristics associated with febrile infectious complication

et al. 2022

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Purpose To evaluate the incidence and risk factors of postoperative fever (POF) after liver resection. In patients with POF, predictors of febrile infectious complications were determined. Methods A total of 797 consecutive patients undergoing liver resection from January 2015 to December 2019 were retrospectively investigated. POF was defined as body temperature ≥ 38.0°C in the postoperative period. POF was characterized by time of first fever, the highest temperature, and frequency of fever. The Institut Mutualiste Montsouris (IMM) classification was used to stratify surgical difficulty, from grade I (low), grade II (intermediate) to grade III (high). Postoperative leukocytosis was defined as a 70% increase of white blood cell count from the preoperative value. Multivariate analysis was performed to identify risk factors for POF and predictors of febrile infectious complications. Results Overall, 401 patients (50.3%) developed POF. Of these, 10.5% had the time of first fever > postoperative day (POD) 2, 25.9% had fever > 38.6°C, and 60.6% had multiple fever spikes. In multivariate analysis, risk factors for POF were: IMM grade III resection (OR 1.572, p = 0.008), Charlson Comorbidity Index score > 3 (OR 1.872, p < 0.001), and serum albumin < 3.2 g/dL (OR 3.236, p = 0.023). 14.6% patients developed infectious complication, 21.9% of febrile patients and 7.1% of afebrile patients (p < 0.001). Predictors of febrile infectious complications were: fever > 38.6°C (OR 2.242, p = 0.003), time of first fever > POD2 (OR 6.002, p < 0.001), and multiple fever spikes (OR 2.039, p = 0.019). Sensitivity, specificity, positive predictive value and negative predictive value for fever > 38.6°C were 39.8%, 78.0%, 33.7% and 82.2%, respectively. A combination of fever > 38.6°C and leukocytosis provided high specificity of 95.2%. Conclusion In this study, we found that IMM classification, CCI score, and serum albumin level related with POF development in patients undergone liver resection. Time of first fever > POD2, fever > 38.6°C, and multiple fever spikes indicate an increased risk of febrile infectious complication. These findings may aid decision-making in patients with POF who require further diagnostic workup.

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“…Postoperative fever is a common feature of spinal surgery and has an incidence rate of 14%-91% depending on the definition of fever and the studied patient population. [1][2][3][4][5][6] Usually, when fever occurs postoperatively in patients, surgeons are eager to rule out an infectious status. However, in most studies, the incidence of infection in patients with postoperative fever is less than 10%, suggesting that fever may not be a specific indicator of infection in the postoperative period.…”

Section: Introductionmentioning

confidence: 99%

A retrospective controlled study of postoperative fever after posterior lumbar interbody fusion due to degenerative lumbar disease

et al. 2022

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Background: Postoperative fever is a common feature of spinal surgery. When fever occurs postoperatively in patients, surgeons are eager to rule out an infection. There are many reports about postoperative fever and infection; however, only a few have described the relationship between degenerative spinal disease and postoperative fever. This study aimed to investigate the causes of postoperative fever in patients with degenerative lumbar disease undergoing posterior screw fixation and interbody fusion and compare patients with non-pathologic fever and infected febrile patients. Methods: From March 2015 to February 2016, 263 patients with degenerative lumbar disease underwent posterior lumbar screw fixation and interbody fusion surgery in our institution. We performed risk factor analysis by categorizing patients as afebrile and febrile. Comparisons were made between afebrile patients and patients with non-pathologic fever, and an analysis was performed between patients with non-pathologic fever and patients with febrile infection. We compared each group by examining the demographic factors before surgery, surgery features, drain duration, and postoperative transfusion. The postoperative day (POD) of fever onset, postoperative fever duration, and blood sample results in patients with fever were investigated. Results: The drain duration was found to be an important factor between the afebrile febrile groups and between the non-pathologic fever and afebrile groups. POD of fever occurred earlier in the non-pathologic group than in the infection group (p = 0.04), and the duration of fever was shorter in the non-pathologic fever group than in the infection group (p = 0.01). Higher procalcitonin levels were observed at POD 5 in the infection group than in the non-pathologic fever group. (p < 0.01) The accidental dural rupture rate was higher in the infected group (p = 0.02); this was thought to be caused by the long non-ambulatory period after surgery. Conclusion: This study identified risk factors and differences between infectious diseases associated with postoperative fever. A significant risk factor for postoperative non-pathological fever was a shorter catheter drainage period. Fever after 3 days, fever for more than 4 days and higher procalcitonin levels after surgery suggest infection.

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Fever Evaluations after Colorectal Surgery: Identification of Risk Factors that Increase Yield and Decrease Cost

Abstract: The current approach to fever evaluation after elective colorectal surgery is low yield and costly. High fever, late postoperative fever, and systemic inflammatory response syndrome are risk factors for a positive fever evaluation after colorectal surgery.

Cited by 16 publications

References 13 publications

Early Postoperative Fever and the “Routine” Fever Work-Up: Results of a Prospective Study

Early Postoperative Fever and the “Routine” Fever Work-Up: Results of a Prospective Study

Postoperative fever after liver resection: Incidence, risk factors, and characteristics associated with febrile infectious complication

A retrospective controlled study of postoperative fever after posterior lumbar interbody fusion due to degenerative lumbar disease

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