Evaluation of Risk Factors for Infectious Morbidity in Postoperative Gynecologic Oncology Patients: A Time for a New Paradigm?

Abstract

This study aimed to determine the postoperative fever index in the gynecologic oncology patient associated with significant infectious morbidity. A retrospective analysis was performed of 355 patients who underwent abdominal surgery. Charts were reviewed to evaluate postoperative temperature and risk factors for infectious morbidity. Statistical analyses were performed as indicated by the data type, including the Student t test, Mann-Whitney U test, χ² test, and 1-way analysis of variance. A value of P < .05 was considered significant. There were 210 patients with temperatures < 100.5°F (group 1), 69 with a temperature ≥ 100.5°F to < 101°F (group 2), and 76 with a temperature ≥ 101°F (group 3). Demographic data were similar among groups. There were 285 diagnostic tests performed, with 51 test results indicative of infectious morbidity. Patients in group 3 underwent more testing and had more positive test results compared with groups 1 and 2. The majority of diagnostic testing and positive test results (60%) were in patients from group 3. Groups 1 and 2 were statistically similar in the number of positive test results and antibiotic duration, demonstrating a lower risk of infectious morbidity compared with group 3. This study suggests that a postoperative temperature of ≥ 101°F appears to be a better predictor of significant infectious morbidity compared with the prior definition of a temperature ≥ 100.5°F. Furthermore, this illustrates the need for the development of a postoperative temperature evaluation protocol to avoid expensive evaluations and empiric treatment of benign causes of postoperative fever.