title: [Postoperative fever in orthopedic and urologic surgery].
abstract: Post-operative fever incidence varies widely. In clean and clean-contaminated surgery the non-infectious fever is more frequent than the infectious fever. We performed a prospective study including 303 patients who underwent orthopedic and urologic elective surgery. The aims of our study were to investigate the incidence of post-operative fever, its etiology, the relationship between time of onset and the etiology, and the usefulness of extensive fever work-up to determine post-operative infection. The incidence of post-operative fever was 14% (42/303) of which 81% (34/42) was noninfectious and 19% (8/42) was infectious. The etiology of the fever in the first 48 hours after surgery was always non-infectious (p < 0.001). An extensive fever work-up was performed in patients who presented fever only after the initial 48 hours of surgery with normal physical examination (n = 19) consisting of chest x-ray, blood (2) and urine cultures. The chest x-ray was normal in all the patients, the urine cultures were positive in four cases (21%, IC 95%: 6-45) and the blood cultures in only one case (5%, IC 95%: 0.1-26). Seven patients had post-operative infections without fever as a clinical sign. The most frequently observed etiology of post-operative fever was non-infectious, related to the normal inflammatory host response to surgery. Based on the present results, the extensive fever work-up performed to investigate post-operative infection does not seem to be a useful tool. The diagnosis of post-operative infection was based on clinical follow up and the correct interpretation of the patient's symptoms and signs.
authors.affiliation: Servicio de Clínica Médica Sanatorio Otamendi Miroli, Buenos Aires, Argentina.
authors.forename: Federico
authors.initials: F
authors.lastname: Saavedra
authors.forename: Cristina
authors.initials: C
authors.lastname: Myburg
authors.forename: Marisa B
authors.initials: MB
authors.lastname: Lanfranconi
authors.forename: Martin
authors.initials: M
authors.lastname: Urtasun
authors.forename: Luis Montes
authors.initials: LM
authors.lastname: De Oca
authors.forename: Andres
authors.initials: A
authors.lastname: Silberman
authors.forename: Alberto
authors.initials: A
authors.lastname: Lambierto
authors.forename: Cesar A
authors.initials: CA
authors.lastname: Gnocchi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001118:Argentina / Q000453:epidemiology; D005260:Female; D005335:Fever of Unknown Origin / Q000453:epidemiology* / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology*; D011184:Postoperative Period; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000150:complications / Q000453:epidemiology*; D014552:Urinary Tract Infections / Q000150:complications / Q000453:epidemiology; D013520:Urologic Surgical Procedures / Q000009:adverse effects*; D055815:Young Adult