Postoperative fever
Postoperative fever is a common condition challenging doctors to find the right diagnosis, because it can be a hallmark of serious underlying conditions. Between 40 and 50 percent of patients develop fever after surgery depending on type of surgery but only a small percentage turn out to be due to infection.[1]
Causes
The most common causes have been summarized in a handy mnemonic: the five W's.[2] These tend to occur at specific days after surgery (postoperative days or POD).
| Category | Day | Description |
|---|---|---|
| Wind | POD1-2 | the lungs, i.e. pneumonia, aspiration, and pulmonary embolism. Once attributed to atelectasis, but a recent review suggests that is not supported by existing clinical evidence.[3][4] |
| Water | POD3-5 | urinary tract infection, related to indwelling catheter (during surgery or currently i.e. Foley catheter ) |
| Walking (or VEINS, which then sounds like "Weins") | POD4-6 | deep vein thrombosis or pulmonary embolism |
| Wound | POD5-7 | surgical site infection, which in obstetrics or gynaecology, may refer to the uterus. |
| Wonder drugs or “What did we do?” | POD7+ | drug fever, infections related to intravenous lines or reaction to blood products |
Numerous variants on the same theme may exist: sometimes another W for "Wonder why" may indicate an abscess somewhere in the body or the site of surgery. Of course, this list is not comprehensive: catheter-related sepsis is also frequent, but also easily recognised.
Postoperative fever can also be brought on by the inflammation involved in the surgery itself, and does not always require medical attention.[5]
Popular culture
In the first season of Grey's Anatomy, Meredith Grey refers to this mnemonic.
References
- ↑ Walid MS, Woodall MN, Nutter JP, Ajjan M, Robinson JS Jr (2009). "Causes and risk factors for postoperative fever in spine surgery patients". South Med J 102 (3): 283–286. doi:10.1097/SMJ.0b013e31819676a4. PMID 19204624.
- ↑ David Cline; Latha G. Stead (10 December 2007). Abdominal Emergencies. McGraw Hill Professional. pp. 146–. ISBN 978-0-07-146861-9. Retrieved 7 August 2010.
- ↑ Pile JC (2006). "Evaluating postoperative fever: a focused approach". Cleve Clin J Med 73 (Suppl_1): S62–6. doi:10.3949/ccjm.73.Suppl_1.S62. PMID 16570551.
- ↑ Mavros MN, Velmahos GC, Falagas ME (2011). "Atelectasis as a cause of postoperative fever: where is the clinical evidence?". Chest 140 (2). doi:10.1378/chest.11-0127. PMID 21527508.
- ↑ Harrison G Weed, MS, MD, FACP; Larry M Baddour, MD, FIDSA. "Postoperative Fever". UpToDate. Retrieved 30 June 2011.
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