Evaluation of postoperative fever: Usefulness and cost-effectiveness of routine workup

Objective: This study was undertaken to determine which investigative tools are of most clinical benefit in a routine postoperative fever workup and to describe which postoperative patients require closer investigation at the time of fever. Study Design: We performed a retrospective analysis of 676 patients undergoing exploratory laparotomy for a gynecologic condition who had a fever of 38.0°C (100.4°F) or higher. Charts were reviewed for independent variables related to their diagnosis and surgery in addition to any workup for fever. An estimate of the total charge of a routine workup was performed. Statistical analysis was performed with SPSS for Windows, version 10.1. Results: We found 194 patients (29%) had a postoperative temperature of 38.0°C or higher. A laboratory/radiographic workup for the fever was performed in 119 women (61%). Only 15% of urinalyses, 14% of urine cultures, 7% of blood cultures, 14% of chest radiographs, and 17% of sputum cultures were positive. There were several significant differences between those with and without serious infections that can guide management of postoperative patients. The total charge for laboratory/radiographic workup was $48,432 or $2201 per serious infection diagnosed. Conclusion: Approximately 29% of women undergoing laparotomy by gynecologists have a fever of 38.0°C (100.4°F) or higher. We found the majority of fever workups were of low clinical yield and added moderate cost. Significant infection is associated with surgery for malignancy, bowel resection, number of febrile days, higher fever, and moderately increased white blood cell count. Only patients with these characteristics are most likely to benefit from laboratory and/or radiographic workup of fever. (Am J Obstet Gynecol 2003;188:1642-7.)