Postoperative fever: A normal inflammatory response or cause for concern

Burke, Lindsay

doi:10.1111/j.1745-7599.2010.00492.x

Cited by 8 publications

(9 citation statements)

References 17 publications

(49 reference statements)

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“…Changes of the leukocytes count were proportional to the changes of the neutrophils count. Numerous studies have shown that elevated body temperature is a frequent sign of the first and second postoperative day in large operative procedures, mostly caused by an inflammatory stimulus of surgery ( 11 , 12 , 13 ). Wortel et al ( 14 ) reported that the postoperative level of IL-6 is directly proportional to the value body temperature.…”

Section: Discussionmentioning

confidence: 99%

Systemic Inflammatory Response Syndrome in Surgical Patients

Smajic¹,

Tupkovic²,

Husić³

et al. 2018

Med Arch

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Objective:To determine the incidence of systemic inflammatory response of the organism in surgical patients and its impact on the outcome of treatment.Methods:A prospective study was conducted on 60 patients undergoing abdominal surgical procedures, between January 2014 and December 2015 in the Surgery Clinic at the University Clinical Center Tuzla. Two groups of thirty were formed by the method of consecutive sampling. The first group consisted of subjects who were prepared for elective abdominal surgery (laparoscopic cholecystectomy), and the second group subjects underwent an emergency surgery due to acute abdomen (laparoscopic cholecystectomy).ResultsThe body temperature difference was statistically significant between the two investigated groups in all stages (c2: t0=3,486; t1=3,098; t2=2,453, t: t0=-11,210; t1=-7,360; t2=-4,927, p < 0,05). Non-elective surgery group had a statistical significant difference of the heart rate at all stages (c2: t0=3,873; t1=3,357; t2=3,227, t: t0=-16,524; t1=-10,407; t2=-9,842, p < 0,05). There is a statistically significant difference in the pCO2 values in all stages between groups (c2: t0=2,582; t1=1,678; t2=1,162, t: t0=4,323; t1=2,653; t2=2,229, p < 0,05). The SIRS score has a good positive correlation with the length of treatment, while the correlation with the outcome of treatment has no statistical significance.ConclusionInflammation scores monitoring in surgical patients is important for the surgical treatment success analysis. By modifying the therapy and influencing the inflammatory response, the results of treatment are improved.

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Section: Discussionmentioning

confidence: 99%

Systemic Inflammatory Response Syndrome in Surgical Patients

Smajic¹,

Tupkovic²,

Husić³

et al. 2018

Med Arch

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“…Moreover, occurrence of postoperative fever does not seem to be related to a worse outcome, which has also been reported in a prospective trial enrolling 2,311 immune suppressed patients with colorectal cancer [18]. If confirmed in other trials, the demand for excessive work-up in patients with early postoperative fever, unless there are additional clinical symptoms and particular comorbidities such as neutropenia, remains questionable [2,4].…”

Section: Discussionmentioning

confidence: 87%

“…Although the association of fever and recent surgery is well known, fever persisting after the third postoperative day is often a concern to surgeons and nurses and leads to further investigation [1][2][3][4]. When an infection is suspected following orthopaedic implant surgery many patients presumably receive antibiotic therapy without clear reason [2,5] or perioperative prophylaxis is prolonged beyond one day in exceptional situations [6], all with potential adverse effects of unnecessary therapy [7].…”

Section: Introductionmentioning

confidence: 99%

Occurrence of fever in the first postoperative week does not help to diagnose infection in clean orthopaedic surgery

Uçkay

Agostinho

Stern

et al. 2010

International Orthopaedics (SICOT)

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Postoperative fever is often misinterpreted as a sign of infection, especially when occurring after the third postoperative day. We assessed the epidemiology of postoperative fever in adult orthopaedic patients and its association with infection. Among 1,073 patients participating in a prospective observational study, 198 (19%) had a postoperative fever (>38°C). Thirteen patients (1.2%) had a surgical site infection and 78 patients (7.3%) had remote bacterial infections during their hospital stay. Including asymptomatic bacteriuria, 174 patients were given antibiotic therapy for a median duration of six days. In multivariate analysis, no clinical parameter was associated with fever, including haematoma (odds ratio 0.9, 95%CI 0.6-1.3), infection (1.6, 0.7-3.7), or antibiotic use (1.6, 0.9-3.0). The maximum temperature on each of the first seven postoperative days did not differ between infected and uninfected patients (Wilcoxon rank-sum tests; p>0.10). We conclude that fever, even up to the seventh postoperative day, is not substantially helpful to distinguish infection from general inflammation in clean orthopaedic surgery.

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“…The most acceptable conclusion was that fever was the physiological response due to the damage caused by surgical trauma, and the degree of fever was correlated with the extent of tissue trauma during surgery [4,8,11,13]. The in ammation reaction stimulated by tissue trauma could trigger the release of cytokines such as IL1, IL6 and TNF-a in the local surgical area, and the released cytokines acted as endogenous pyrogens to stimulate the preoptic area of the hypothalamus to increase prostaglandin production, raising the thermoregulatory set point for body temperature [9,13,14,19,20]. Based on these theories, we proposed that when the drainage tube was removed, the local in ammatory cytokines could not ow out, and then a small hematoma formed.…”

Section: Discussionmentioning

confidence: 99%

A Randomized Study on The Prophylactic Use of Acetaminophen to Prevent Fever After The Removal of Drainage Tubes in Lumbar Surgery

Yang

Xing

et al. 2021

Preprint

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Study design: a prospectively random clinical trialObjective: To explore the efficacy of prophylactic use of Acetaminophen in preventing fever after the removal of tube drainage in lumbar surgery.Summary and background data: Many inpatients encountered a fever in the first 24 hours when the drainage tube was removed. When fevers appeared, it was costly to exclude the possibility of deep infection and always failed to identify the etiology. Just like the postoperative fever, we suggested that the fever was caused by the normal inflammatory response, and tried to figure out whether the prophylactic use of Acetaminophen could lower the possibility of fever or not.Methods: 183 consecutive patients undergoing lumbar spine surgery were prospectively randomized into 2 groups. 91 patients were allocated into the study group, they would receive a pill of Acetaminophen (Tylenol, 650mg) before the removal of lumbar tube drainage, and another one at 8p.m. The rest 92 patients were divided into the control group, they were treated in routine treatment without Acetaminophen. In the first 24 hours, a temperature higher than 37.7°C was defined as fever. The 2 groups were then compared for differences in age, gender, height, weight, body mass index (BMI), surgical segments, surgical time, blood loss, blood transfusion, American Society of Anesthesiologists (ASA) score, duration of the tube drainage, total volume of the drainage collection, variation of the levels of WBC, CRP, hospital stay since the removal of drainage to discharge and the rate of fever.Results: There were no differences in all the basic information of 2 groups, but the fever rate of the 2 groups had significant differences (P=0.006), the fever rate of the study group (14/91, 15.38%) was significant lower than the control group (30/92, 32.61%).Conclusion: Fever after the removal of tube drainage was caused by normal inflammation response, and a small dose of acetaminophen could significantly lower the possibility fever. Trail registration: This trail was registered in the ClinicalTrial.gov PRS on July 13, 2019, and the ID was NCT04042948.

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Postoperative fever: A normal inflammatory response or cause for concern

Cited by 8 publications

References 17 publications

Systemic Inflammatory Response Syndrome in Surgical Patients

Systemic Inflammatory Response Syndrome in Surgical Patients

Occurrence of fever in the first postoperative week does not help to diagnose infection in clean orthopaedic surgery

A Randomized Study on The Prophylactic Use of Acetaminophen to Prevent Fever After The Removal of Drainage Tubes in Lumbar Surgery

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