Published in:
01-05-2008 | Original Contribution
Fever Evaluations after Colorectal Surgery: Identification of Risk Factors that Increase Yield and Decrease Cost
Published in: Diseases of the Colon & Rectum | Issue 5/2008
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Purpose
This study was designed to evaluate the yield and cost of fever evaluations in average-risk inpatients after elective colorectal surgery.
Methods
A 12-month, retrospective study was performed on patients who developed a postoperative fever ≥ 38°C after elective colorectal surgery. A positive fever evaluation was defined as a blood culture, urine culture, chest x-ray, or abdominal CT result that led to a change in patient management. Logistic regression, Fisher’s exact test, and chi-squared test were used; odds ratios were calculated.
Results
Of 133 patients, 26 percent had a positive evaluation. Blood culture, urine culture, chest x-ray, and CT were positive in 3, 8, 7, and 46 percent, respectively. Risk factors for a positive fever evaluation were temperature ≥ 38.5°C, fever evaluation after postoperative Day 6, and a clinical manifestation of systemic inflammatory response syndrome other than fever (all, P < 0.01). The cost per positive fever evaluation for the entire group, patients with 2 risk factors, or patients with 3 risk factors was $5,600, $4,200, and $2,140, respectively.
Conclusions
The current approach to fever evaluation after elective colorectal surgery is low yield and costly. High fever, late postoperative fever, and systemic inflammatory response syndrome are risk factors for a positive fever evaluation after colorectal surgery.