From the Guidelines
The wind-water-wound rule is a mnemonic used to identify potential causes of post-operative fever based on timing, with wind referring to atelectasis, water representing urinary tract infections, and wound indicating surgical site infections. This rule is based on the typical timing of when these conditions are most likely to cause fever after surgery. According to the most recent and highest quality study 1, the management of surgical site infections involves suture removal, incision and drainage, and adjunctive systemic antimicrobial therapy in certain cases. The study also recommends a brief course of systemic antimicrobial therapy for patients with surgical site infections following clean operations on the trunk, head and neck, or extremities that also have systemic signs of infection. Some key points to consider when evaluating post-operative fever include:
- Atelectasis typically causes fever within the first 24-48 hours after surgery due to shallow breathing and poor lung expansion 1.
- Urinary tract infections commonly present with fever around days 3-5 post-operatively, often related to urinary catheterization 1.
- Surgical site infections typically manifest with fever around days 5-7 after surgery as bacteria multiply in the incision area 1. It's essential to note that any post-operative fever warrants a complete assessment rather than relying solely on timing, as exceptions to this pattern are common. The algorithm for the management and treatment of surgical site infections (SSIs) provided in the study 1 can help guide clinicians in making targeted treatment decisions. Overall, the wind-water-wound rule provides a useful framework for identifying potential causes of post-operative fever, but it should be used in conjunction with a thorough clinical evaluation and consideration of individual patient factors.
From the Research
Postoperative Fever Evaluation
The wind, water, wound rule is a mnemonic used to evaluate postoperative fever, as mentioned in the study 2. This rule helps to identify potential causes of fever in postoperative patients.
- Wind: Refers to pulmonary causes such as pneumonia, aspiration, and pulmonary embolism.
- Water: Refers to urinary tract infections.
- Wound: Refers to surgical site infections.
- Additionally, the study 2 mentions "what did we do?" which refers to iatrogenic causes such as drug fever, blood product reaction, and infections related to intravenous lines.
Importance of Evaluation
It is essential to evaluate postoperative fever systematically to rule out life-threatening conditions, as stated in the study 3. The study 4 also emphasizes that any fever in a surgical patient is a cause for concern and should be investigated further.
Diagnostic Approach
The study 5 suggests a systematic diagnostic strategy to determine when postoperative fever is a normal inflammatory response or a cause for concern. This approach involves considering factors such as the patient's medical history, physical examination findings, and type of surgery to order appropriate diagnostic tests.
Limitations of Current Evidence
While the studies provide guidance on evaluating postoperative fever, they do not offer a comprehensive solution to the problem. Further research is needed to develop more effective strategies for managing postoperative fever.