Conservative Management of Postoperative Fever in Gynecologic Patients Undergoing Major Abdominal or Vaginal Operations
| Autor: | Jacob M. Estes, J. Michael Straughn, Kristopher J. Kimball, Charles A. Leath, James E. Kendrick, T. Michael Numnum |
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| Rok vydání: | 2008 |
| Předmět: |
Adult
medicine.medical_specialty Adolescent Genital Neoplasms Female Ovariectomy medicine.medical_treatment Observation Physical examination Hysterectomy Fever of Unknown Origin Patient Readmission law.invention Postoperative fever Postoperative Complications Risk Factors law Cefotetan medicine Humans Prospective Studies Antipyretic Prospective cohort study Fallopian Tubes Aged Aged 80 and over medicine.diagnostic_test business.industry Incidence (epidemiology) Analgesics Non-Narcotic Middle Aged medicine.disease Intensive care unit Anti-Bacterial Agents Surgery medicine.anatomical_structure Abdominal Neoplasms Abdomen Female business Algorithms Follow-Up Studies medicine.drug |
| Zdroj: | Journal of the American College of Surgeons. 207:393-397 |
| ISSN: | 1072-7515 |
| Popis: | Background To develop a standardized protocol for management of postoperative fever in gynecology patients to decrease unnecessary diagnostic workups and empiric use of antibiotics. Study Design A prospective analysis of postoperative gynecology patients identified those who experienced fever (maximum temperature [T max ] > 100.4°F). Patients were triaged into low- and high-risk groups. High-risk patients were managed independent of the protocol. High-risk criteria included bowel operation, preoperative infection, immunodeficiency, indwelling vascular access, mechanical heart valves, and intensive care unit admissions. Low-risk patients were treated with observation and antipyretics. Patients with persistent or high fever, defined as T max > 101°F for > 48 hours, were evaluated and treated based on physical examination findings. Results We evaluated 292 postoperative patients. Forty-seven percent of patients had a final diagnosis of malignancy. Sixty-four patients were high-risk and 33% of these patients experienced fever. Using the standardized protocol, 228 low-risk patients were managed. Thirty-seven of the 228 patients (16%) had fever postoperatively. Nineteen patients had low-grade fever (100.4 to 101°F); none of these patients required antibiotics. Seventeen patients had fever (101.1 to 102°F) and one patient had fever > 102°F. Using the protocol, 6 of 37 patients (16%) were treated with antibiotics for an infectious diagnosis. Conclusions Although postoperative fever is common in gynecologic patients, the incidence of infection is low (3%). A standardized postoperative fever protocol in low-risk gynecology patients decreases use of empiric antibiotics without compromising morbidity. |
| Databáze: | OpenAIRE |
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