Conservative management of postoperative Fever in gynecologic patients undergoing major abdominal or vaginal operations.
BACKGROUND
To develop a standardized protocol for management of postoperative fever in gynecology patients to decrease unnecessary diagnostic workups and empiric use of antibiotics.


METHODS
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.
Kendrick
James E
JE
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Alabama at Birmingham, AL 35249-7333, USA.
Numnum
T Michael
TM
Estes
Jacob M
JM
Kimball
Kristopher J
KJ
Leath
Charles A
CA
Straughn
J Michael
JM
D000008:Abdominal Neoplasms / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015313:Cefotetan / Q000627:therapeutic use*; D005187:Fallopian Tubes / Q000601:surgery; D005260:Female; D005335:Fever of Unknown Origin / Q000188:drug therapy* / Q000209:etiology; D005500:Follow-Up Studies; D005833:Genital Neoplasms, Female / Q000601:surgery*; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D019370:Observation; D010052:Ovariectomy; D010359:Patient Readmission; D011183:Postoperative Complications / Q000188:drug therapy* / Q000209:etiology; D011446:Prospective Studies; D012307:Risk Factors
D018712:Analgesics, Non-Narcotic; D000900:Anti-Bacterial Agents; D015313:Cefotetan