Postoperative fever is defined as a temperature >100.4°F (38°C) on 2 consecutive postoperative days, or >102.2°F (39°C) on any 1 postoperative day.
The reported incidence varies, but it can be expected in about 13% to 14% of patients. Most cases are self-limiting, requiring only observation. However, it is crucial to recognize a small subset of patients who require further investigation and treatment for a serious underlying cause.
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. After 48 hours, the incidence of infectious etiologies increases and a complete blood count, 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 toward the suspected etiology.
- Drug fever
- Myocardial infarction
- Alcohol withdrawal
- Fat embolism
- Transfusion reaction
- Transplant rejection
- Toxic shock syndrome
- Ischemia of operated tissue
- Gout exacerbation
- Pseudogout exacerbation
- Acalculous cholecystitis
- Malignant hyperthermia
- Hyperthyroidism exacerbation
- Pheochromocytoma exacerbation
- Adrenal crisis
- Transfusion-related infection
- Underlying malignancy
- Meningitis post neurosurgery
- Subarachnoid hemorrhage post neurosurgery
- Otitis media post ENT surgery
- Sinusitis post nasogastric tube insertion
- Cavernous sinus thrombosis post ENT or neurosurgery
- Osteomyelitis following orthopedic surgery
- Infective endocarditis following cardiac surgery
Jeff House, DO, FACP
Program Director Internal Medicine
University of Florida-Health Science Center
Internal Medicine Residency Program
JH declares that he has no competing interests.
Irene Alexandraki, MD, MPH, FACP
Professor of Medicine
Florida State University
College of Medicine
IA declares that she has no competing interests.
A. Sahib El-Radhi, MRCPCH, FRCPCH, DCH, PhD
Honorary Senior Lecturer
Chelsfield Park Hospital
ASER declares that he has no competing interests.
John M. Embil, MD, FRCPC
Section of Infectious Diseases
Department of Medicine
University of Manitoba
Infection Prevention and Control Unit Health Sciences Centre
JME declares that he has no competing interests.
Stephen G. Baum, MD
Professor of Medicine
Department of Microbiology and Immunology
Albert Einstein College of Medicine
SGB declares that he has no competing interests.
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