Introduction
Postoperative fever, defined as a body temperature ≥38.3°C (100.9°F), is a common clinical scenario encountered in the post-surgical setting. The fever can arise from a variety of causes, which can be systematically approached using the "5 W’s" framework: Wind, Water, Wound, Walking, and Wonder Drugs.
Key Causes of Postoperative Fever
Wind:
Pneumonia: Often within the first 48 hours. Patients may exhibit cough, dyspnea, and abnormal chest auscultation findings.
Atelectasis: Also within the first 48 hours. It is often subclinical and resolves with aggressive pulmonary hygiene.
Water:
Urinary Tract Infection: Typically presents post-3 days. Symptoms include dysuria, frequency, and lower abdominal pain.
Wound:
Surgical Site Infection: Can occur anytime but often presents after day 5. Look for erythema, swelling, warmth, and purulent discharge.
Walking:
Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE): Usually presents post-5 days. Symptoms include unilateral leg swelling and pain for DVT, and chest pain, dyspnea, and tachycardia for PE.
Wonder Drugs:
Drug-induced Fever: Can occur at any time. It is a diagnosis of exclusion after ruling out other causes.
Diagnostic Approach
History and Physical Examination:
Timing of fever onset post-surgery.
Review of systems targeting respiratory, urinary, and surgical site symptoms.
Assess for risk factors like type and duration of surgery, patient medical history.
Laboratory and Imaging Studies:
CBC with Differential: For elevated WBC.
Blood Cultures: In cases of high fever or sepsis.
Urinalysis and Urine Culture: For UTI evaluation.
Chest Radiography: For suspected pneumonia or atelectasis.
Ultrasound/Doppler: For DVT.
Wound Culture: If a surgical site infection is suspected.
Management Strategies
Wind (Pneumonia, Atelectasis):
Pneumonia: Incentive spirometry, chest physiotherapy, and antibiotics if confirmed.
Atelectasis: Aggressive pulmonary hygiene.
Water (UTI):
Remove indwelling catheters.
Antibiotics based on culture results.
Wound (Surgical Site Infection):
Incision and drainage if an abscess is present.
Tailored antibiotics.
Walking (DVT/PE):
Anticoagulation therapy.
Early postoperative mobilization.
Wonder Drugs (Drug-induced Fever):
Discontinue suspected medications.
Supportive care.
Conclusion
Postoperative fever requires a systematic approach to identify and manage the underlying cause effectively. Using the "5 W’s" framework ensures a comprehensive evaluation and targeted treatment, improving patient outcomes.
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