causes of post op fever

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WeeklyMedReview No. 4 - Causes of Postoperative Fever | Science Medicine LifeWarning: The NCBI website requires JavaScript to operate. NCBI Bookshelf. Service of the National Library of Medicine, National Institutes of Health. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan... StatPearls [Internet]. Postoperative FeverTony A. Abdelmaseeh; Chaudhary Ehtsham Azmat; Tony I. Oliver.AuthorsAfiliations Last updated: November 4, 2020. Continuous educational activity Postoperative fever is defined as a temperature above 38 C (or above 100.4 F) in two consecutive postoperative days or more than 39 C (or more than 102.2 F) on any postoperative day. Knowledge of differential diagnosis, as well as a systematic approach, is useful in reducing differential diagnosis and instituting appropriate management. This activity examines the causes of postoperative fever and highlights the role of the interprofessional team in its management. Objectives:Introduction Postoperative fever is defined as a temperature above 38 C (or above 100.4 F) in two consecutive postoperative days or more than 39 C (or more than 102.2 F) in any postoperative day. Knowledge of differential diagnosis, as well as a systematic approach, is useful in reducing differential diagnosis and instituting appropriate management. Fever, as a manifestation of sepsis, should be identified quickly and properly managed to reduce mortality rates in such cases. Etiology Time has a strong influence on etiology. Epidemiology Postoperative fever is very common. The exact incidence of postoperative fever is not known, but the numbers are high. The estimates of the different surgical procedures reveal that the fever occurs early in the postoperative period anywhere from 20% to 90% of patients. In most of these cases, fever usually occurs on the first or second day after surgery and has been linked to atelectasis. It is known that postoperative fever occurs after all types of surgical procedures, regardless of the type of anesthesia. Fever also occurs in children and both sexes. Postoperative fever may occur after minor surgical procedures but is rare and depends on the type of procedure. In general, both abdominal and chest procedures cause the highest incidence of postoperative fever. PatophysiologySystemic Inflammatory Response Syndrome (SIRS): Systemic Inflammation Response Syndrome ():Four criteria that include: Two of the 4 criteria are needed to identify a patient with SIRS. Two of the SIRS criteria plus a suspicious source of sepsis is necessary to diagnose sepsis. Operating signs of the Fever History and Physics OrganImmediate FeverFever occurs immediately after surgery or within hours on postoperative days (POD) 0 or 1.Acute FeverAcute FeverFever occurs in the first week (1 to 7 POD). Subacute fever Subacute feverIt occurs between the postoperative weeks 1 and 4. Delayed feverFever after more than 4 weeks. The previous differential diagnosis is for causes that are classified according to time. However, there are many other causes that may have specific signs in the physical examination and occur after specific surgery that are not included in the previous differential. EvaluationInternal evaluation includes the general aspect, the GSP and vital signs to determine the patient's disease. Treatment / ManagementThe treatment may include oxygen, fluid balance, intravenous fluids and a urinary catheter or antibiotics. Differential Diagnosis As mentioned above, differences are based on the time of fever, among other factors. Some of the important differences are listed below. Prognosis In most patients, postoperative fever is due to a benign cause and resolves spontaneously. Patients who have atelectasis recover quickly once they start at spirometry of incentives and/or chest physical therapy. Patients with deep vein thrombosis and pulmonary embolism usually have a low-grade fever that resolves in a few days of treatment. The prognosis is worse for patients who have anastomotic leaks or intestinal obstruction. Complications Failure to diagnose the cause of the fever or identify the severity of the fever may lead the patient to SIRS, sepsis, severe sepsis or septic shock. This can lead to prolonged hospitalization and even increase the mortality rate. Consultations Deterrence and Patient Education Patients suffering from general anesthesia should be advised to use incentive spirometry to prevent atelectasis, which is a common cause of postoperative fever. Early mobilization should also be encouraged in postoperative patients where permitted. Improvement of Health Equipment Results Postoperative fever is a common occurrence in all surgical floors. Because there are so many causes of fever, the problem is usually managed by an interprofessional team of health professionals. The nurse is probably the first person to watch the patient and discover the fever. To know the cause, the nurse must first check the wound site, hide the lungs and evaluate for deep vein thrombosis. Other causes of postoperative fever may be a urinary tract infection, an intravenous line (trombophlebitis), or sepsis. Once the fever has been observed, the health care provider must be notified, and the work depends on the patient's presentation and the day of the fever. If atelectasis is suspected, a chest X-ray, a culture of blood and urine for sepsis, and a urinary tract infection and a duplex ultrasound may be ordered if a deep vein thrombo is suspected. The key is to examine the patient as it can provide a clue to the cause. (Level V)Continue education/examination questionsReferences This book is distributed under the terms of the Creative Commons 4.0 International License (), which allows the use, duplication, adaptation, distribution and reproduction in any medium or format, provided that you give appropriate credit to the original author(s) and source, a link to the Creative Commons license is provided, and changes are indicated. ViewsIn this PageRelated information Similar products in PubMed Recent activityYour navigation activity is empty. The activity recording is off. , 8600 Rockville Pike, Bethesda MD, 20894 USA

Postoperative fever Postoperative fever refers to a high body temperature (≥38.5°C) that occurs after a recent surgical procedure. Diagnosis of the cause of postoperative fever may sometimes be difficult; while fever in this context may be benign, self-limited or unrelated to the surgical procedure, it may also be indicative of a surgical complication, such as infection. Postoperative feverContentsCauses[ ]The most common causes of postoperative fever are often summed up for medical students at first with the letter W. The classic list consists of five W: Wind, Water, Sound, Walking and Wonder Drugs, but also two other causes should be considered: Wing/Waterway and (W)abscess. There is a characteristic time frame after surgery when many of these complications tend to develop (postoperative days or POD). Category Day Description Wind POD 1-2 lungs, that is, aspiration and pulmonary embolism; it has been commonly cited as cause of postoperative fever, but lacks evidence of support Water POD 3-5 , possibly associated with catheter (if a urinary catheter was inserted during surgery or remains in place at present i.e. ) Wound POD 5-7 surgical incision infection, whether superficial or deep (W)abscess POD 5-7 organ or space infection Walking (or VEINS pronounced as "Weins") POD 5+ (risk may persist for months after operation) or I wonder drugs or "What did we do?" Always or reaction to blood products, either to Wing/Waterway Always blood flow infection, phlebitis or cellulite related to intravenous lines, either central or peripheral Other major causes of early postoperative fever that are omitted from this list include, a life-threatening but treatable response to anesthetic and paralytic inhalers. Early postoperative fever (i.e., within the first 48 hours after the operation) has often been attributed to atelectasis, or spine, but it is highly likely to be part of a natural and non-infectious inflammatory response (with the involvement of the sympathetic nervous system) to the sustained tissue injury during the surgery; usually it does not require any medical intervention except antipyrethics and extra intake of fluid. Workup[]The diagnosis of postoperative fever is guided by possible etiologies in differential diagnosis. The patient's surgical and postoperative course should be checked in detail, noting whether the patient has been using a incentive spirometer or not regularly, if a Foley catheter was in place, what medicines he received, etc. The patient should be asked if he has any pain (and where?) or other symptoms such as cough or dysuria, which can help locate the source of the fever. A thorough physical examination, auscultation of the lungs, erythema or drainage of the surgical incision, evaluation of sites IV, noting edema of the lower extremity, etc. Laboratory tests and images are usually deducted for the evaluation of the fever that occurs in the first 48 hours after the operation, unless indicated by specific findings in history and physical examination. Beyond 48 hours, the test routinely includes urine and blood cultures, as well as chest X-ray. Popular culture[ ]In the medical drama Grey Anatomy, Meredith Grey refers to this mnemonic: "Wind, water, wound, walking, wonders. 5 Ws. Most of the time is wind; styling or pneumonia. Pneumonia is easy to assume. Especially if you're too busy to test. " ###################### #################################################################################################################################################################################################################################### cold Aches and and Several .mw-parser-output .nobold{font-weight:normal}heat cold Navigation menu Personal tools Named spaces Variants Views More Search Navigation Contributed Tools Printing/exporting Languages

Tyler Larsen on Twitter: "1/ Does atelectasis cause post-operative fever? I occasionally hear atelectasis listed in the differential diagnosis for early post-op fever (EPF) but this idea has never made much physiologic

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