From the Guidelines
A surgical fever is typically defined as a body temperature of 38.5°C or higher, occurring after a surgical procedure, and warrants investigation if it persists beyond 48 hours, exceeds 39°C, or is accompanied by other concerning symptoms. According to the most recent and highest quality study 1, fever in the early postoperative period (within 48 hours) is usually non-infectious in origin. However, once a patient is 96 hours postoperative, fever is likely to represent infection. The management of surgical fever depends on the cause, but may include antipyretics, adequate hydration, and appropriate antibiotics if infection is confirmed.
Key Considerations
- Early surgical fevers (within 48 hours) are often due to the normal inflammatory response to tissue trauma or atelectasis (collapsed lung tissue) 1.
- Fevers occurring 3-5 days post-surgery may indicate wound infections, urinary tract infections, or pneumonia, while those appearing after 5 days might suggest deep surgical site infections or other complications like deep vein thrombosis 1.
- A chest radiograph is not mandatory for evaluation of postoperative fever unless respiratory rate, auscultation, abnormal blood gas, or pulmonary secretions suggest a high probability of utility 1.
- Urinary tract infection is common postoperatively because of the use of urinary drainage catheters, and the duration of catheterization is the most important risk factor for the development of nosocomial cystitis or pyelonephritis 1.
- New or persistent fever days after surgery should raise a strong suspicion of persistent pathology or a new complication, and it is mandatory to remove the surgical dressing to inspect the wound 1.
Recommendations
- Surgical fevers should be investigated if they persist beyond 48 hours, exceed 39°C, or are accompanied by other concerning symptoms.
- Antipyretics like acetaminophen (500-1000mg every 6 hours) and adequate hydration may be used to manage surgical fever.
- Incentive spirometry may be used to prevent atelectasis.
- Appropriate antibiotics should be used if infection is confirmed.
From the Research
Definition of Surgical Fever
- Surgical fever is defined as a core temperature of ≥38.2 degrees C for at least 72 consecutive hours 2
- Postprocedure fevers vary in the timing of their occurrence, duration, and severity, and do not all have an infectious cause, but they all require thorough investigation to rule out life-threatening conditions 3
Temperature Threshold
- A core temperature of ≥38.2 degrees C is considered a fever in the postoperative period 2
- Maintaining normothermia with active warming, such as warmed intravenous fluids, skin warming, and warm forced air, to keep the body temperature warmer than 36 °C is recommended to reduce the risk of surgical site infections 4