Fever

Postoperative Fever

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Postoperative Fever, Post-operative Fever, Fever in the Post-surgical Patient, Postoperative Infection

  • 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]
  • 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)
  • 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
  • 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)