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Obstetrics & Gynecology 2008;111:1137-1142
© 2008 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Explained Compared With Unexplained Fever in Postoperative Myomectomy and Hysterectomy Patients

Eli A. Rybak, MD, MPH1, Alex J. Polotsky, MD, MS1, Tinsay Woreta, MD4, Susan M. Hailpern, DrPH, MS2 and Robert E. Bristow, MD3

From the 1Division of Reproductive Endocrinology and Infertility and the 2Department of Epidemiology and Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York; 3Kelly Gynecologic Oncology Service and the 4School of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland.

OBJECTIVE: To confirm that fever with localized findings is less prevalent among febrile postoperative myomectomy patients than it is among hysterectomy patients.

METHODS: Hospital records of 341 hysterectomy patients and 250 myomectomy patients were reviewed. Rate of overall febrile morbidity, proportion of fever with localized findings, proportion of febrile patients worked-up, and other perioperative parameters were recorded. Fever was prospectively defined both inclusively (temperature at least 38.0°C occurring at least 4 hours postoperatively) and in standard fashion (temperature at least 38.0°C after 24 hours postoperatively). A localized fever required a positive laboratory, radiologic, or clinical finding. Chi-square, Student t test, and multivariable logistic regression were used.

RESULTS: The proportion of patients who developed postoperative fever after at least 4 hours was identical between myomectomy and hysterectomy patients (39.2% compared with 39.3%, P=.98). However, the proportion of febrile myomectomy patients with localized findings was significantly lower than hysterectomy patients (14.3% compared with 31.3%, P=.003). Likewise, when comparing respective rates of overall and localized fever after at least 24 hours postoperatively, similar results were obtained. Multivariable analysis confirmed the lower likelihood of localized findings among febrile postoperative myomectomy patients compared with hysterectomy patients (odds ratio of localized fever 0.30, 95% confidence interval 0.12–0.75, P=.01). Additionally, obesity raised the likelihood of localized findings in each group by 6% per unit of body mass index (odds ratio 1.06, 95% confidence interval 1.01–1.10, P=.03).

CONCLUSION: Overall postoperative fever rates are similar, but myomectomy is independently associated with fewer localized fevers than hysterectomy. Given the relatively low likelihood of localized fever, clinicians may consider simplifying the fever workup of postoperative myomectomy patients.

LEVEL OF EVIDENCE: II






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