de la Torre Sarah H, Mandel Lynn, Goff Barbara A
Department of Obstetrics and Gynecology, University of Washington Medical Center, Seattle, 98195, USA.
Am J Obstet Gynecol. 2003 Jun;188(6):1642-7. doi: 10.1067/mob.2003.397.
This study was undertaken to determine which investigative tools are of most clinical benefit in a routine postoperative fever workup and to describe which postoperative patients require closer investigation at the time of fever.
We performed a retrospective analysis of 676 patients undergoing exploratory laparotomy for a gynecologic condition who had a fever of 38.0 degrees C (100.4 degrees F) or higher. Charts were reviewed for independent variables related to their diagnosis and surgery in addition to any workup for fever. An estimate of the total charge of a routine workup was performed. Statistical analysis was performed with SPSS for Windows, version 10.1.
We found 194 patients (29%) had a postoperative temperature of 38.0 degrees C or higher. A laboratory/radiographic workup for the fever was performed in 119 women (61%). Only 15% of urinalyses, 14% of urine cultures, 7% of blood cultures, 14% of chest radiographs, and 17% of sputum cultures were positive. There were several significant differences between those with and without serious infections that can guide management of postoperative patients. The total charge for laboratory/radiographic workup was 48,432 US dollars or 2201 US dollars per serious infection diagnosed.
Approximately 29% of women undergoing laparotomy by gynecologists have a fever of 38.0 degrees C (100.4 degrees F) or higher. We found the majority of fever workups were of low clinical yield and added moderate cost. Significant infection is associated with surgery for malignancy, bowel resection, number of febrile days, higher fever, and moderately increased white blood cell count. Only patients with these characteristics are most likely to benefit from laboratory and/or radiographic workup of fever.
本研究旨在确定在常规术后发热检查中哪些检查工具具有最大的临床益处，并描述哪些术后患者在发热时需要更密切的检查。
我们对676例因妇科疾病接受剖腹探查术且体温达到38.0摄氏度（100.4华氏度）或更高的患者进行了回顾性分析。除了对发热进行的任何检查外，还查阅了与她们的诊断和手术相关的独立变量的病历。对常规检查的总费用进行了估算。使用Windows版SPSS 10.1进行统计分析。
我们发现194例患者（29%）术后体温达到38.0摄氏度或更高。119名女性（61%）针对发热进行了实验室/影像学检查。尿液分析、尿培养、血培养、胸部X光片和痰培养的阳性率分别仅为15%、14%、7%、14%和17%。有严重感染和无严重感染的患者之间存在一些显著差异，这些差异可指导术后患者的管理。实验室/影像学检查的总费用为48432美元，或每诊断出一例严重感染为2201美元。
妇科医生进行剖腹手术的女性中，约29%的患者体温达到38.0摄氏度（100.4华氏度）或更高。我们发现大多数发热检查的临床收益较低且成本适中。严重感染与恶性肿瘤手术、肠道切除、发热天数、更高的体温以及白细胞计数适度增加有关。只有具有这些特征 的患者最有可能从发热的实验室和/或影像学检查中受益。
