Medline ® Abstracts for References 3-7

of 'Postoperative fever'

3
TI
Unexplained in-hospital fever following cardiac surgery. Natural history, relationship to postpericardiotomy syndrome, and a prospective study of therapy with indomethacin versus placebo.
AU
Livelli FD Jr, Johnson RA, McEnany MT, Sherman E, Newell J, Block PC, DeSanctis RW
SO
Circulation. 1978;57(5):968.
 
In Part I of this study, the in-hospital course of 219 patients who had undergone a cardiac operation is analyzed. Fever (greater than or equal to 37.8 degrees C, rectal) was present after postoperative day 6 in 159 patients (73%) and was of unexplained cause in 118. Fever decay in the population of unexplained fever patients was exponential. All patients with unexplained postoperative fever were afebrile by postoperative day 19. In-hospital pericardial rub and pleuritic chest pain, widening of the mediastinum on chest film, and pleural effusion were not specifically associated with unexplained postoperative fever. In Part II, 67 patients with unexplained postoperative fever were given indomethacin (100 mg per day) or placebo for 7 days by a randomized, double-blind protocol. Indomethacin resulted in a shorter duration of fever (2.4 vs 3.5 days, P is less than 0.01) and in a shorter duration of chest pain, malaise, and myalgias compared to placebo. Sixty-seven percent of the patients in Part I and all of the patients in Part II were contacted 2-8 months following hospital discharge. Five percent had experienced an illness that we considered to be acute pericarditis, but its occurrence was unrelated to whether the patient had had in-hospital unexplained postoperative fever, in-hospital rub or chest pain, or in-hospital administration of indomethacin.
AD
PMID
4
TI
Fever after craniofacial surgery in the infant under 24 months of age.
AU
Hobar PC, Masson JA, Herrera R, Ginsburg CM, Sklar F, Sinn DP, Byrd HS
SO
Plast Reconstr Surg. 1998;102(1):32.
 
A retrospective review was undertaken of 126 consecutive craniofacial procedures involving a transcranial component, performed at the Children's Medical Center at Dallas, between 1990 and 1994. Standard postoperative axillary temperature measurements were recorded until discharge. Age at surgery of less than 24 months correlated very strongly with a postoperative temperature of greater than 38 degrees C (r = -0.92). The incidence of postoperative fever was high in all age groups, yet there was still a significant difference between the group younger than 2 years and the group in which surgery was performed after the age of 2 years across all postoperative temperature ranges, from>38 degrees C to>39.5 degrees C (p<0.001, chi-square test). The white blood cell count was elevated above the age-related normal in 67 percent of febrile patients. There was no correlation between type or duration of surgical procedure, length of intensive care or hospital stay, or the need for blood transfusion and the development of a significant postoperative fever. There were minor infectious complications in four patients (3 percent), only one of which was a wound problem related to the surgery. All infectious complications were easily identifiable clinically. There was no mortality or serious infections. The development of postoperative fever, and an elevated white blood cell count, is to be expected inpediatric patients undergoing craniofacial procedures. The routine laboratory investigation of postoperative fever in pediatric craniofacial patients under 2 years of age without procedures involving transgression of the paranasal sinuses is not warranted unless there are associated clinical indicators.
AD
Department of Plastic and Reconstructive Surgery, Children's Medical Center, Dallas 75235, USA.
PMID
5
TI
Fever following total knee arthroplasty.
AU
Guinn S, Castro FP Jr, Garcia R, Barrack RL
SO
Am J Knee Surg. 1999;12(3):161.
 
This study investigated the incidence and clinical significance of postoperative fever in 118 consecutive patients undergoing 141 total knee arthroplasties (TKAs). A postoperative fever was recorded in 63 (66%) of 95 unilateral and 17 (74%) of 23 bilateral TKA patients. Nine of the unilateral and five bilateral TKA patients developed positive clinical or laboratory findings to explain the pyrexia. Unilateral TKA patients who experienced postoperative fever were statistically more likely to have a complication in the immediate postoperative period. None of the surgical variables examined had any predictive value on the incidence of postoperative fever. Aggressive pulmonary toilet, repeated physical examinations, and urine analysis are recommended when evaluating TKA patients with postoperative fever. Fever following TKA was common and was not necessarily a contraindication to discharge.
AD
Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.
PMID
6
TI
Pyrexia following total knee replacement.
AU
Ghosh S, Charity RM, Haidar SG, Singh BK
SO
Knee. 2006;13(4):324.
 
This study aims to determine the incidence and factors associated with pyrexia following total knee replacement (TKR). We performed a retrospective analysis of the temperature charts and histories of patients who underwent 170 TKRs. There was a statistically significant increase in mean temperature from pre-operation to post-operation, and this increase remained significant through to 5 days post surgery (p<0.0001). Sixty-two (36.5%) patients were pyrexial (>or=38 degrees C) at some point. Fourteen patients developed a clinical infection, but only four of these were pyrexial. There was no association between pyrexia and infection, allogenic blood transfusion, haemoglobin loss, use of urinary catheter, rheumatoid arthritis, anaesthetic type, and previous pyrexia following TKR. Pyrexia as a diagnostic test for the development of infection had a sensitivity of 0.286 (95% CI=0.084-0.581), specificity of 0.628 (95% CI=0.548-0.704) and positive predictive value of 0.065 (95% CI=0.018-0.157). Pyrexia in the first 5 days following TKR is usually a normal physiological response and should not cause undue concern about the presence of infection.
AD
Department of Trauma and Orthopaedic Surgery, City Hospital, Dudley Road, Birmingham B18 7QH, UK.
PMID
7
TI
Utility of blood cultures in postoperative pediatric intensive care unit patients.
AU
Kiragu AW, Zier J, Cornfield DN
SO
Pediatr Crit Care Med. 2009;10(3):364.
 
OBJECTIVE: To determine the frequency of positive blood cultures in patients with fevers in the initial 48-hour postoperative period.
STUDY DESIGN: All patients who had blood cultures drawn during the initial 48 hours postoperatively while in the pediatric intensive care unit (PICU) at the University of Minnesota Children's Hospital-Fairview during an 18-month period were included in the current study. Six hundred two postoperative patients were admitted to the PICU during the study period. Patients with a temperature>100.4 degrees F and who had blood cultures drawn were identified. Patients for whom the operative procedure was not the first in that admission, those discharged in<48 hours, and those with an indwelling central venous catheter for>24 hours before their admission were excluded.
RESULTS: Sixty-six of these patients were febrile and had blood cultures drawn in the initial 48 hours postoperatively. One hundred eleven blood cultures were obtained. A single (0.9%) blood culture was positive. The cost per positive culture was estimated at $23,532.
CONCLUSIONS: Even in patients admitted to the PICU, fever in the initial 48-hour postoperative period is unlikely to represent bacteremia in low-risk pediatric patients. Blood cultures in these patients are, therefore, unlikely to yield positive results. Procurement of blood cultures in this patient population is not justified. Cessation of the practice of blood culture procurement in this patient population may both focus care and provide enable meaningful cost savings.
AD
Department of Pediatrics, Center for Excellence in Pulmonary Biology, Stanford University, Stanford, CA, USA.
PMID