II. Causes: Early Postoperative Fever
- Major surgery
- Results in fever in 15-40% on postoperative day 1 (most without infection)
- Major surgery related early fever resolves in first 24-48 hours (if not infectious)
- Fever in first 48 hours in non-infectious in 90% of cases
- Malignant Hyperthermia (Anesthetic induced)
-
Atelectasis is NOT a cause of fever
- Atelectasis is coincidental with Post-operative Fever and resolves in the same timeline
- Engoren (1995) Chest 107(1):81-4 +PMID:7813318 [PubMed]
- Warlitier (2005) Anesthesiology 102:838-854 +PMID:15791115 [PubMed]
III. Causes: Infectious
- Soft-tissue infection (including Necrotizing Fasciitis)
- Pneumonia
- Clostridium difficile
- Abdominal surgery complications (e.g. anastomotic leak or abscess)
- Urinary Tract Infection
- Infected Joint Replacement (or other infected prosthesis)
- Catheter Related Bloodstream Infection (CRBI)
IV. Causes: Noninfectious
- Atelectasis is NOT a cause of fever (see above)
- Pulmonary Embolism
- Alcohol Withdrawal
-
Adrenal Insufficiency
- Consider Hydrocortisone IV in addition to other management
V. Evaluation
- Evaluate for Sepsis (Vital Signs, SIRS Criteria, Lactic Acid)
- Evaluate for source
- Labs (e.g. Urinalysis)
- Imaging (e.g. Chest XRay, Abdominal CT)
- Obtain cultures (Blood Cultures, Urine Culture)