The value of postoperative fever evaluation

Evaluation of fever in the early postoperative period often includes a battery of diagnostic tests to determine the source of or to exclude a serious infection. In order to evaluate the clinical usefulness and cost effectiveness of the information obtained from these tests, the data for 464 patients who had undergone abdominal operation were reviewed. Of the 464 patients, 71 (15%) fulfilled the criterion of fever with rectal temperature of 38.5 °C or greater in the first 6 postoperative days. For 27% (19/71) of the patients with a postoperative fever, culture-proven infection was responsible for the fever. For 74% (14/19) of the patients with infection, the correct diagnosis was made based on clinical findings and confirmed by a single appropriate test. The remaining five patients with infection were diagnosed via a battery of tests because of the absence of clinical findings indicating the source of their infection. Rote ordering of unnecessary tests resulted in an excess expenditure of $19,738, or $278 per febrile patient. We conclude that routine evaluations of fever do not alter the outcome of the majority of patients and are not cost effective.