II. Causes: Early Postoperative Fever

  1. Major surgery
    1. Results in fever in 15-40% on postoperative day 1 (most without infection)
    2. Major surgery related early fever resolves in first 24-48 hours (if not infectious)
  2. Malignant Hyperthermia (Anesthetic induced)
  3. Atelectasis is NOT a cause of fever
    1. Atelectasis is coincidental with Post-operative Fever and resolves in the same timeline
    2. Engoren (1995) Chest 107(1):81-4 +PMID:7813318 [PubMed]
    3. Warlitier (2005) Anesthesiology 102:838-854 +PMID:15791115 [PubMed]

III. Causes: Infectious

  1. Soft-tissue infection (including Necrotizing Fasciitis)
  2. Pneumonia
  3. Clostridium difficile
  4. Abdominal surgery complications (e.g. anastomotic leak or abscess)
  5. Urinary Tract Infection
  6. Infected Joint Replacement (or other infected prosthesis)
  7. Catheter Related Bloodstream Infection (CRBI)

IV. Causes: Noninfectious

  1. Atelectasis is NOT a cause of fever (see above)
  2. Pulmonary Embolism
  3. Alcohol Withdrawal
  4. Adrenal Insufficiency
    1. Consider Hydrocortisone IV in addition to other management

V. Evaluation

  1. Evaluate for Sepsis (Vital Signs, SIRS Criteria, Lactic Acid)
  2. Evaluate for source
    1. Labs (e.g. Urinalysis)
    2. Imaging (e.g. Chest XRay, Abdominal CT)
  3. Obtain cultures (Blood Cultures, Urine Culture)

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Related Studies

Ontology: Postoperative infection (C0392618)

Concepts Pathologic Function (T046)
ICD9 998.5
SnomedCT 213290006, 157790006, 269448008, 33910007
English Postoperative infection NOS, postoperative infection, postoperative infection (diagnosis), Infection;post-op, infections post op, infection postoperative, infection post op, infections postoperative, Postoperative infection NOS (disorder), Post-op. infection, Infection: post-op., Postoperative infection, Postoperative infection (disorder), post-op infection
Dutch postoperatieve infectie NAO, postoperatieve infectie
French Infection postopératoire SAI, Infection post-opératoire
German postoperative Infektion NNB, postoperative Infektion
Italian Infezione post-operatoria, Infezione post-operatoria NAS
Portuguese Infecção pós-operatória, Infecção pós-operatória NE
Spanish Infección posoperatoria NEOM, Infección postoperatoria, infección posquirúrgica, SAI, infección posquirúrgica, SAI (trastorno), infección posoperatoria, infección postoperatoria (trastorno), infección postoperatoria
Japanese ジュツゴカンセン, ジュツゴカンセンNOS, 術後感染NOS, 術後感染
Czech Pooperační infekce NOS, Pooperační infekce
Hungarian Postoperativ fertőzés k.m.n., Postoperativ fertőzés

Ontology: Postoperative fever (C0424786)

Concepts Pathologic Function (T046)
SnomedCT 248450003
Italian Febbre post-operatoria
Japanese 術後発熱, ジュツゴハツネツ
Czech Pooperační horečka
Hungarian Műtét utáni láz
English Postoperative fever, Postoperative fever (finding), fever; postoperative, postoperative; fever
Dutch koorts; postoperatief, postoperatief; koorts, postoperatiekoorts
Spanish fiebre posoperatoria (hallazgo), fiebre posoperatoria, Fiebre postoperatoria
Portuguese Febre pós-operatória
French Fièvre post-opératoire
German postoperatives Fieber