Prospective analysis of a fever evaluation algorithm after major gynecologic surgery

OBJECTIVE: We performed a prospective trial to evaluate the feasibility acc uracy, and safety of a postoperative fever algorithm that is based on sympt oms and physical examination in an attempt to decrease the random use of ur ine cultures, blood cultures. and chest radiographs. STUDY DESIGN: Our lever algorithm consisted of assessing ail febrile postop erative patients for signs and symptoms of infection. If none were present, no tests were ordered. RESULTS: Twenty-eight of 105 consecutive patients (27%) had postoperative f ever after major gynecologic surgery. Three of 28 febrile patients (11%) we re evaluated with tests according to the algorithm. Two of 28 febrile patie nts (7%) were evaluated in violation of the algorithm. Four febrile patient s (14%) had documented infections. Two patients had infections within the f irst 30 days after discharge. Compared with our previous retrospective revi ew, significantly fewer febrile patients were evaluated with testing with a significantly increased yield of positive test results. CONCLUSIONS: Our postoperative fever evaluation algorithm that is based on symptoms and physical examination is feasible, is safe, decreases random te sting, and increases the yield of positive test results.