by Dr Kanis Fatema,Intern Doctor,Sylhet MAG Osmani Medical College

1. POSTOPERATIVE
PYREXIA
PRESENTED BY KANIS FATEMA
Intern Doctor,Surgery unit-1,
SOMCH

2. FEVER
 Fever implies an elevated core
body temperature of more than
38.0⁰ C
Ref:Davidson’s Principle & Practice of Medicine:23rd Edition

3. Classification
of fever
• Fluctuation not >1.5⁰F in 24
hours
• Never touches baseline
Continuous
/persistent
• Touches baseline in 24 hoursIntermittent
• Fluctuation not >3⁰F in 24
hours
• Never touches baseline
Remittent

5. Pathophysiology of Pyrexia
Infection,Microbial Toxin,Mediators of Inflammation,Immune Reaction
Activation of Macrophages, Endothelial cells & Others
Pyrogenic Cytokines (IL-1, IL-6, TNF,IFN)
Acts on hypothalamic endothelium & release of PG-E
Elevated thermoregulatory set point
Ref:Harrison’s Principle of Internal Medicine

6. WHAT IS POSTOPERATIVE
PYREXIA AND WHY IS IT
NECESSARY TO
EVALUATE?

7. What Is Postoperative Pyrexia And
Why Is It Necessary To Evaluate?
Elevation of body temperature greater
than 38.0⁰C or 100.4⁰F following surgical
procedures is known as Postoperative
pyrexia

8. Cont… Fever is one of the most common postoperative
complications seen in medical & surgical settings.
Clinicians taking care of these patients need to be able
to differentiate between a normal physiologic response
to surgery and one that may be pathogenic.
A systemic approach to febrile postoperative patients
can help doctors make better use of resources, limit
costly workups and improve patient outcomes

9. Cont… • About 40% patients develop pyrexia after
surgery , however in most cases no cause
is found.
• The inflammatory response to surgical
trauma may manifest itself as fever so
pyrexia does not necessarily imply sepsis.
• However in all patients with pyrexia a focus
of infections should be sought.

10. CAUSES OF
POSTOPERATIVE PYREXIA

11. According to
the time of
onset…
Atelectasis of the lungsDays 2-5

12. Superficial and Deep wound
infections
• Days 3-5

13. Day 5 Chest Infection
Urinary Tract Infection
Thrombophlebitis

14. >5 days Anastomotic Leakage
Intra-CavitaryCollections
Abscesses
Wound infection
Ref:Bailey & Love’s Short Practice of Surgery : 26TH Edition

15. Non infected
origin
DVT
Transfusion reactions
Wound haematomas
Ref:Bailey & Love’s Short Practice of Surgery : 26TH Edition

16. APPROACH TO A FEBRILE
POSTOPERATIVE
PATIENT

17. Approach to a febrile postoperative
patient
Look for Important features-
Time of onset
Degree of pyrexia & type
Accompaniments, particularly rigors
(shivering) & haemodynamic change
Ref:Cuschieri Essential Surgical Practice:5th Edition

18. HISTORY
TAKING

19. Take History When to examine further
Fever that persists beyond 1st
24 hours
Fever that recurs after a
period without fever
(intermittent)
Fever that arises after the first
24 hours
Fever accompanied by rigors,
haemodynamic changes or
chest /abdominal signs
Ref:Cuschieri Essential Surgical Practice:5th Edition

20. PHYSICAL
EXAMINATION

21. • Physical examination
• Chest
• Wound
• Calf muscle tenderness
• Catheter and intravenous
sites
• Pressure areas
Ref:Cuschieri Essential Surgical Practice:5th Edition

22. INVESTIGATIONS

23. Investigations • If a patient develops pyrexia a
routine “infection screen” is carried
out
• Chest X-ray
• Culture screen
(Sputum,Urine,Blood,Wound Swab)
• Full Blood Count (Particularly WBC
for Leucocytosis)
• Ultrasonography of Whole Abdomen
• ECG
• Doppler Ultrasound for Suspected
DVT
Ref:Clinical Surgery in General (RCS Course manual):4th Edition;
Principles & Practise of Surgery:7th Edition

24. MONITORING

25. Monitoring/
Follow Up
• Check vitals regularly
• Maintain temperature chart to
see patterns of fever
• Check dressing pads (soaked
or dry)
• Hydration status

26. TREATMENT

27. General Management:
Maintenance of Proper Hydration ( Intravenous or Enteral)
Maintenance of Intake & Output
Proper Nutrition
Oral Hygiene
Care of Catheter, Intravenous Channels, Tubes, Surgical Wounds
Early mobilization
Chest Physiotherapy
Nursing care: advise tepid sponging, temperature monitoring and
charting, exposure

28. Specific Management:
Management depends on the cause
Atelectasis-incentive spirometry
Infective cause-start empirical antibiotics while waiting for
C/S
Remove/replace source of infection
• Foleys catheter,central venous lines,Intravenous IV
• Drainage, debridement and/or irrigation of infected
wounds

29. Cont…
• DVT-Treatment with Parenteral Anti-coagulant initially followed by
longer term Warfarin or new oral Anti-coagulant
• Urinary Tract Infection: Treatment involves adequate hydration,
proper bladder drainage & Antibiotics depending on the
sensitivity of the microorganisms
Ref:Cuschieri Essential Surgical Practice:5th Edition; Bailey &
Love’s Short Practice of Surgery 27th edition;Principles & Practice
of Surgery:7th edition

30. Complications
• Undiagnosed infection can
cause sepsis and even death
• Prolonged hospitalization
Ref:NCBI Journals

31. Thank you