Fever Evaluation, Complication and Treatment in Surgical Patients

Fever following surgery is a common event occurring in 14%-91% of postoperative patients. Fever can occur immediately after surgery and seen to be related directly to the operation or may occur sometime after the surgery as a result of complication related to surgery. Although the list of causes of postoperative fever is extensive, the initial focus for most patients should be on a limited number of the more common infectious and noninfectious causes. The classic W5 of postoperative fever are as follows: Wind: atelectasis on postoperative day 1-2, Water: urinary tract infection on postoperative day 2-3, Wound: wound infection on postoperative day 3-7, Walking: deep venous thrombosis/thrombophlebitis on postoperative day 5-7, and Wonder Drug: drug fever on postoperative day>7. Postoperative fever evaluations should take into account numerous factors including timing, the patient’s own medical, surgical, and social history, as well as details of the procedure including significant events comprising the patient’s preoperative, intraoperative, and postoperative period. A focused physical assessment and any additional symptoms the patient is experiencing should be taken into account in evaluating the clinical significance of a postoperative fever and determining appropriate action. Treatments for the postoperative fever are all dependent on the etiology. Thus, identifying the likely cause through a thorough patient history and physical examination becomes critical.