Fever, Leucocytosis and Infection after Open Heart Surgery. A Log-linear Regression Analysis of 115 Cases

Abstract

A prospective investigation was undertaken in adults to assess the specificity and sensitivity of fever (greater than 38 degrees C) and leucocytosis (greater than 10 000/microliters) for the diagnosis of infection after operations with cardiopulmonary bypass. A log-linear model analysis of a multiway frequency table was used for statistical evaluation. The model parameters were separately evaluated for 2 periods: the early one until the 6th day, the late period from the 7th postoperative day until discharge. Seven out of 115 patients suffered infections during their hospital stay: Bacteremia occurred in 3, pneumonia in 2, and deep sternal wound infection in 2 patients, and a superficial wound infection in one. No significant interactions between fever, leucocytosis and/or infection were found in the first period, except an inverse relation between fever and elevated WBC (p = 0.0197). After the 6th postoperative day the model parameters did show significant interactions, fever and leucocytosis being more frequent in infected patients. However, the specificity was low: only 15% of the patients with fever or elevated WBC had an infection. The risk of in-hospital infection was significantly higher after a long duration of cardiopulmonary bypass (p = 0.009), and after transfusion of more than 2500 ml of blood on the day of operation (p = 0.001).

Leukocytosis after robotic hysterectomy: commonly observed but clinically insignificant

“…One study of 185 patients after cardiac valve surgery demonstrated the unreliability of leukocytosis and fever [4]. Another study noticed that signs of fever and leukocytosis were more frequent in infected patients but only after the sixth postoperative day [5]. Furthermore, these parameters lack speciWcity: only 15% of patients with fever or elevated WBC count after the sixth postoperative day had infection.…”

Potential clinical applications of c‐reactive protein

“…The value of serial CRP determinations in postoperative patients who have undergone cardiac surgery is well-established (39)(40)(41). Studies have demonstrated the usefulness of CRP in predicting postoperative infectious complications before the onset of clinical symptoms.…”

Postoperative Subphrenic Abscess after Heart-valve Replacement

“…Postoperative subphre nic abs cesses are complicati ons most frequently observed after abd ominal surgeries (4,5). To our knowledge ther e are no reports of subphrenic absces ses after ca rdiac su rgery .…”

“…Sometimes, the paucity of symptoms and signs makes the identification of a subphrenic abscess difficult (4), as occurred in our pati ent. Perop er ative antibiotics may have been resp onsible for suppression of the symptoms (4,5). We hypoth esize that the ab scess was provoked by a lesion of the diaphragm caused by inadequate care in applying the right pleural drainage.…”