Transactions of the Sixty-Ninth Annual Meeting of the Pacific Coast Obstetrical and Gynecological Society
Evaluation of postoperative fever: Usefulness and cost-effectiveness of routine workup

Presented at the Seventy-First Annual Meeting of the Pacific Coast Gynecological and Obstetrical Society, October 22-27, 2002, Rancho Mirage, Calif.
https://doi.org/10.1067/mob.2003.397Get rights and content

Abstract

Objective: This study was undertaken to determine which investigative tools are of most clinical benefit in a routine postoperative fever workup and to describe which postoperative patients require closer investigation at the time of fever. Study Design: We performed a retrospective analysis of 676 patients undergoing exploratory laparotomy for a gynecologic condition who had a fever of 38.0°C (100.4°F) or higher. Charts were reviewed for independent variables related to their diagnosis and surgery in addition to any workup for fever. An estimate of the total charge of a routine workup was performed. Statistical analysis was performed with SPSS for Windows, version 10.1. Results: We found 194 patients (29%) had a postoperative temperature of 38.0°C or higher. A laboratory/radiographic workup for the fever was performed in 119 women (61%). Only 15% of urinalyses, 14% of urine cultures, 7% of blood cultures, 14% of chest radiographs, and 17% of sputum cultures were positive. There were several significant differences between those with and without serious infections that can guide management of postoperative patients. The total charge for laboratory/radiographic workup was $48,432 or $2201 per serious infection diagnosed. Conclusion: Approximately 29% of women undergoing laparotomy by gynecologists have a fever of 38.0°C (100.4°F) or higher. We found the majority of fever workups were of low clinical yield and added moderate cost. Significant infection is associated with surgery for malignancy, bowel resection, number of febrile days, higher fever, and moderately increased white blood cell count. Only patients with these characteristics are most likely to benefit from laboratory and/or radiographic workup of fever. (Am J Obstet Gynecol 2003;188:1642-7.)

Section snippets

Material and methods

We conducted an 18-month retrospective chart review of women undergoing exploratory laparotomy by the Gynecologic Oncology and Benign Gynecology Services at the University of Washington Medical Center from November 1999 to May 2001. Approval from the Institutional Review Board was obtained through expedited review. All patients were included regardless of diagnosis or severity of illness. There were only two patients who had evidence of serious infections before surgery, one with pneumonia and

Results

A total of 676 patients underwent major gynecologic surgery through an abdominal incision from November 1999 to May 2001 and 196 patients (28.9%) met the criteria for febrile morbidity and 194 (28.6%) patients were used in the data analysis after 2 patients with preoperative infections were excluded. Of the 194 patients, 125 (64%) had a fever 38.5°C (101.3°F) or higher, 122 (63%) had a diagnosis of gynecologic cancer, and 21 (11%) underwent a bowel resection. Table I describes the patient

Comment

Fever is a normal host response to endogenous and exogenous pyrogens. An exogenous pyrogen is typically a microorganism or its byproducts and stimulates fever by inducing formation of an endogenous pyrogen. An endogenous pyrogen can be an immune complex, complement, steroid hormone metabolite, or cytokine and works by resetting the thermoregulatory center in the anterior hypothalamus. Interleukins 1 and 6 (IL-1, IL-6), tumor necrosis factor α and β and interferon alfa are the major pyrogenic

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Reprint requests: Barbara Goff, MD, Division of Gynecology Oncology, Department of Obstetrics and Gynecology, Box 356460 University of Washington Medical Center, Seattle, WA 98195.

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