Postoperative fever
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Postoperative fever is a common condition challenging doctors to find the right diagnosis, because it can be a hallmark of serious underlying conditions. Between 40-50% of surgical patients develop postoperative fever depending on type of surgery but only a small percentage turn out to be due to infection.[1]
Causes
The most common causes have been summarized in a handy mnemonic: the five W's.[2] These tend to occur at specific days after surgery (postoperative days or POD).
| Category | Day | Description |
|---|---|---|
| Wind | POD1-2 | the lungs, i.e. pneumonia, aspiration, and pulmonary embolism. Once attributed to atelectasis, but this has been shown to be inaccurate.[3] |
| Water | POD3-5 | urinary tract infection, related to indwelling catheter (during surgery or currently i.e. Foley catheter ) |
| Walking (or VEINS, which then sounds like "Weins") | POD4-6 | deep vein thrombosis or pulmonary embolism |
| Wound | POD5-7 | surgical site infection, which in obstetrics or gynaecology, may refer to the uterus. |
| Wonder drugs or “What did we do?” | POD7+ | drug fever, infections related to intravenous lines |
Numerous variants on the same theme may exist: sometimes another W for "Wonder why" may indicate an abscess somewhere in the body or the site of surgery. Of course, this list is not comprehensive: catheter-related sepsis is also frequent, but also easily recognised.
Popular culture
In the first episode of Grey's Anatomy, Meredith refers to this mnemonic.
References
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- ↑ Walid MS, Woodall MN, Nutter JP, Ajjan M, Robinson JS Jr (2009). "Causes and risk factors for postoperative fever in spine surgery patients". South Med J. 102 (3): 283–286. doi:10.1097/SMJ.0b013e31819676a4. PMID 19204624.
- ↑ David Cline; Latha G. Stead (10 December 2007). Abdominal Emergencies. McGraw Hill Professional. pp. 146–. ISBN 9780071468619. Retrieved 7 August 2010.
- ↑ Pile JC (2006). "Evaluating postoperative fever: a focused approach". Cleve Clin J Med. 73: S62–6. doi:10.3949/ccjm.73.Suppl_1.S62. PMID 16570551.
