From the Guidelines
A surgical fever is typically defined as a body temperature of 100.4°F (38°C) or higher following a surgical procedure, as stated in the guidelines for the diagnosis and management of skin and soft tissue infections 1. This elevation in temperature often occurs within the first 48 hours after surgery and is considered a normal physiological response to surgical trauma. The body's inflammatory response to tissue injury during surgery can trigger the release of pyrogens, which reset the body's temperature regulation center in the hypothalamus. If a fever persists beyond 48-72 hours post-surgery, rises above 102°F (38.9°C), or is accompanied by other concerning symptoms such as increasing pain, redness, or drainage at the surgical site, it may indicate a complication such as an infection and should be reported to a healthcare provider immediately. Management typically involves monitoring the temperature, ensuring adequate hydration, and sometimes using antipyretics like acetaminophen (Tylenol) at standard doses (325-650mg every 4-6 hours, not exceeding 3000mg daily) to improve comfort. Some key points to consider in the management of surgical fevers include:
- Fever in the first 48 hours after surgery is often not due to infection, but rather a response to surgical trauma 1.
- The definition of fever can vary, but a temperature of 100.4°F (38°C) or higher is commonly used 1.
- Antibiotics are not routinely prescribed for early post-surgical fevers unless there are clear signs of infection, such as purulent drainage, positive culture, or marked local signs of inflammation 1.
- The algorithm for the management and treatment of surgical site infections (SSIs) should be followed, which includes opening the wound, evacuating infected material, and continuing dressing changes until the wound heals by secondary intention 1. It's worth noting that other studies, such as those related to febrile neutropenia management in patients with acute lymphoblastic leukemia, may define fever differently, such as a single temperature ≥ 38.3°C (101°F) or ≥ 38.0°C (100.4°F) over a 1-hour period 1. However, in the context of surgical fevers, the definition of 100.4°F (38°C) or higher is most commonly used and accepted 1.
From the Research
Definition of Surgical Fever
- A surgical fever is generally considered to be a temperature greater than or equal to 100.4° F 2 or 101.5 degrees F 3 in the postoperative period.
- The definition of surgical fever may vary slightly depending on the source, but a temperature above 100.4° F is commonly used as a threshold for evaluation 2.
Evaluation of Postoperative Fever
- Postoperative fever is a common event, occurring in 23.7% of patients undergoing in-patient general surgical procedures 2.
- The evaluation of postoperative fever often includes diagnostic tests such as blood cultures, urine cultures, and chest radiographs 2, 4.
- However, the yield of these diagnostic tests is often low, and a brief bedside evaluation may be more effective in determining the etiology of the fever 2.