Wang Shiqi, Ji Gang, Feng Xiangying, Huang Luguang, Luo Jialin, Yu Pengfei, Zheng Jiyang, Yang Bin, Wang Xiangjie, Zhao Qingchuan
Xijing Hospital of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
Medical Information Department, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
Interact J Med Res. 2024 Oct 9;13:e50585. doi: 10.2196/50585.
Postoperative fever frequently indicates surgical complications and is commonly used to evaluate the efficacy of interventions against surgical stress. However, the presence of circadian rhythms in body temperature may compromise the accurate detection of fever.
This study aimed to investigate the detection rate of fever under intermittent measurement.
We retrospectively reviewed the clinical records of patients who underwent nonemergency gastrointestinal surgery between November 2020 and April 2021. Patients' temperature data were continuously collected every 4 seconds using a wireless axillary thermometer, and fever was defined as a temperature exceeding 38 °C within a day. To simulate intermittent measurement in clinical practice, the body temperature at each hour was selected from the continuously collected temperature dataset. Considering that temperatures are measured multiple times per day, all possible measurement plans using intermittent measurement were composed by combining 1-24 time points from the 24-hour daily cycle. Fever was clinically diagnosed based on the temperature readings at the selected time points per day. The fever detection rates for each plan, with varying measurement times, were listed and ranked.
Based on the temperature data continuously collected by the thermometer, fever occurred in 60 (40.8%) of the 147 included patients within 3 days after surgery. Of the measurement plans that included 1-24 measurements daily, the fever detection rates ranged from 3.3% (2/60) to 85% (51/60). The highest detection rates and corresponding timings for measurement plans with 1, 2, 3, and 4 measurements daily were 38.3% (23/60; at 8 PM), 56.7% (34/60; at 3 AM and 7 or 8 PM), 65% (39/60; at 3 AM, 8 PM, and 10 or 11 PM), and 70% (42/60; at 12 AM, 3 AM, 8 PM, and 11 PM), respectively; and the lowest detection rates were 3.3% (2/60), 6.7% (4/60), 6.7% (4/60), and 8.3% (5/60), respectively. Although fever within 3 days after surgery was not correlated with an increased incidence of postoperative complications (5/60, 8.3% vs 6/87, 6.9%; P=.76), it was correlated with a longer hospital stay (median 7, IQR 6-9 days vs median 6, IQR 5-7 days; P<.001).
The fever detection rate of the intermittent approach is determined by the timing and frequency of measurement. Measuring at randomly selected time points can miss many fever events after gastrointestinal surgery. However, we can improve the fever detection rate by optimizing the timing and frequency of measurement.
术后发热常提示手术并发症，常用于评估针对手术应激的干预措施的疗效。然而，体温的昼夜节律可能会影响发热的准确检测。
本研究旨在探讨间歇测量下发热的检测率。
我们回顾性分析了2020年11月至2021年4月期间接受非急诊胃肠道手术患者的临床记录。使用无线腋温计每4秒连续收集患者的体温数据，发热定义为一天内体温超过38℃。为模拟临床实践中的间歇测量，从连续收集的温度数据集中选取每小时的体温。考虑到每天测量多次体温，通过组合每日24小时周期中的1 - 24个时间点，构成了所有可能的间歇测量方案。根据每天选定时间点的体温读数进行临床发热诊断。列出并排序了不同测量时间的每个方案的发热检测率。
根据温度计连续收集的体温数据，147例纳入患者中有60例（40.8%）在术后3天内出现发热。在每日包含1 - 24次测量的测量方案中，发热检测率在3.3%（2/60）至85%（51/60）之间。每日测量1次、2次、3次和4次的测量方案的最高检测率及相应测量时间分别为38.3%（23/60；晚上8点）、56.7%（34/60；凌晨3点和晚上7点或8点）、65%（39/60；凌晨3点、晚上8点和晚上10点或11点）和70%（42/60；凌晨12点、凌晨3点、晚上8点和晚上11点）；最低检测率分别为3.3%（2/60）、6.7%（4/60）、6.7%（4/60）和8.3%（5/60）。虽然术后3天内发热与术后并发症发生率增加无关（5/60，8.3%对6/87，6.9%；P = 0.76），但与住院时间延长相关（中位数7天，四分位间距6 - 9天对中位数6天，四分位间距5 - 7天；P < 0.001）。
间歇测量方法的发热检测率取决于测量时间和频率。在随机选择的时间点进行测量可能会遗漏胃肠道手术后的许多发热事件。然而，我们可以通过优化测量时间和频率来提高发热检测率。
