خلاصه
Postoperative fever is defined as a temperature >38°C (100°F) on 2 consecutive postoperative days, or >39°C (102.2°F) on any 1 postoperative day. It is a common problem encountered by both surgeons and medical consultants. The reported incidence varies, but can be expected in about 13-14%. [1] Most cases are self-limiting, requiring only observation. However, it is crucial to recognise a small sub-set of patients who require further investigation and treatment for a more serious underlying cause. Causes of postoperative fever presenting up to and including 4 weeks postoperatively are discussed here.
The differential diagnosis is strongly influenced by the time of onset of the fever. The most common cause of fever within the first 48 hours is a pyretic response to surgery, which is self-limiting. Diagnostic testing is usually unrevealing in this period unless associated symptoms and signs suggest an underlying cause. [2] [3] After 48 hours, the incidence of infectious aetiologies increases and an FBC, chest radiograph, urinalysis with culture, blood cultures, and wound cultures are required as first tests in all patients. Further radiological or laboratory testing is directed towards the suspected aetiology.
تشخيص افتراقی
- Common
- Uncommon
-
- Transfusion reaction
- Transplant rejection
- Toxic shock syndrome
- Sinusitis post nasogastric tube insertion
- Acalculous cholecystitis
- Meningitis post neurosurgery
- Otitis media post ENT surgery
- Sialadenitis
- Transfusion-related infection
- Seroma
- Subarachnoid haemorrhage post neurosurgery
- Drug fever
- Alcohol withdrawal
- Malignant hyperthermia
- Fat embolism
- Myocardial infarction
- Stroke
- Cavernous sinus thrombosis post ENT or neurosurgery
- Ischaemia of operated tissue
- Gout exacerbation
- Pseudogout exacerbation
- Hyperthyroidism exacerbation
- Phaeochromocytoma exacerbation
- Underlying malignancy
- Adrenal crisis
- Pancreatitis
