Most postlaparotomy fevers don't need work-up. (Low-Risk Asymptomatic Patients).

RANCHO MIRAGE, CALIF. -- Fevers occurring in the first 24 hours after laparotomy require no laboratory or other testing, unless the patient is symptomatic, researchers concluded after studying fevers in nearly 200 postoperative patients.

Dr. Sarah de la Torre and her associates at the University of Washington reviewed charts of 676 women undergoing exploratory laparotomy for various gynecologic conditions and discovered that 29% had fevers of at least 38[degrees] C for at least two consecutive measurements taken at least 1 hour apart.

Most fevers (61%) prompted a medical work-up, but just 22 of 119 patients were determined to have a serious infection. In 33 cases, a minor infection such as a urinary tract infection or superficial wound cellulitis was discovered, but in 140 cases, no infection was found to explain the patient's fever, Dr. de la Torre said in a poster presentation at the annual meeting of the Pacific Coast Obstetrical and Gynecological Society.

Extensive investigations, which included blood tests, urinalyses and urine cultures, chest x-rays, and sputum cultures, cost a total of $48,432, which averages out to $2,201 to identify each serious infection.

To better identify which patients are most likely to have serious infections, they further investigated characteristics of the 22 patients who were found to have pneumonia (10), bacteremia (6), wound infection (3), sepsis (2), fistula (2), abdominal abscess (1), or Clostridium difficile (1).

It turned out that these patients were far more likely than others to have a malignancy (16% ...