| Title | Conservative management of postoperative Fever in gynecologic patients undergoing major abdominal or vaginal operations. | | Author(s) | Kendrick JE, Numnum TM, Estes JM, Kimball KJ, Leath CA, Straughn JM | | Institution | Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Alabama at Birmingham, AL 35249-7333, USA. | | Source | J Am Coll Surg 2008 Sep; 207(3):393-7. | | MeSH | Abdominal Neoplasms
Adolescent
Adult
Aged
Aged, 80 and over
Algorithms
Analgesics, Non-Narcotic
Anti-Bacterial Agents
Cefotetan
Fallopian Tubes
Female
Fever of Unknown Origin
Follow-Up Studies
Genital Neoplasms, Female
Humans
Hysterectomy
Middle Aged
Observation
Ovariectomy
Patient Readmission
Postoperative Complications
Prospective Studies
Risk Factors
| | Abstract | BACKGROUND: To develop a standardized protocol for management of postoperative fever in gynecology patients to decrease unnecessary diagnostic workups and empiric use of antibiotics.
STUDY DESIGN: A prospective analysis of postoperative gynecology patients identified those who experienced fever (maximum temperature [T(max)] > 100.4 degrees F). Patients were triaged into low- and high-risk groups. High-risk patients were managed independent of the protocol. High-risk criteria included bowel operation, preoperative infection, immunodeficiency, indwelling vascular access, mechanical heart valves, and intensive care unit admissions. Low-risk patients were treated with observation and antipyretics. Patients with persistent or high fever, defined as T(max) > 101 degrees F for > 48 hours, were evaluated and treated based on physical examination findings.
RESULTS: We evaluated 292 postoperative patients. Forty-seven percent of patients had a final diagnosis of malignancy. Sixty-four patients were high-risk and 33% of these patients experienced fever. Using the standardized protocol, 228 low-risk patients were managed. Thirty-seven of the 228 patients (16%) had fever postoperatively. Nineteen patients had low-grade fever (100.4 to 101 degrees F); none of these patients required antibiotics. Seventeen patients had fever (101.1 to 102 degrees F) and one patient had fever > 102 degrees F. Using the protocol, 6 of 37 patients (16%) were treated with antibiotics for an infectious diagnosis.
CONCLUSIONS: Although postoperative fever is common in gynecologic patients, the incidence of infection is low (3%). A standardized postoperative fever protocol in low-risk gynecology patients decreases use of empiric antibiotics without compromising morbidity. | | Language | eng | | Pub Type(s) | Comparative Study
Journal Article
| | PubMed ID | 18722945 |
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