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Predictive Value for Infection of Febrile Morbidity After Vaginal Surgery

From the Departments of Obstetrics and Gynecology, East Carolina University, Greenville, North Carolina; Penn State Geisinger Health System, Hershey, Pennsylvania; and Christiana Care Health Services, Wilmington, Delaware.

Address reprint requests to: D. Paul Shackelford, MD Department of Obstetrics and Gynecology East Carolina University Greenville, NC 27858-4354

Objective: To determine the screening value of febrile morbidity for detecting infections after vaginal surgery.

Methods: A cohort of 431 consecutive women had vaginal surgery at the M. S. Hershey Medical Center from September 1988 through June 1995. Outcomes of febrile morbidity and infection were analyzed.

Results: Fifty-four of 431 patients (12.5%) had febrile morbidity. Thirty-five infections (8.1%) were identified, of which only 13 were accompanied by febrile morbidity. Forty-one patients (9.5%) had unexplained fevers. The sensitivity of febrile morbidity for postoperative infection was 40%, specificity was 98%, positive predictive value was 26%, and negative predictive value was 94%. Stepwise logistic regression found blood loss (odds ratio 1.001/mL; confidence interval 1.0001–1.0035), uterine weight (0.987/g; 0.976–0.999), and parity (1.570; 1.146–2.050) as significant independent variables for developing fever. Patient weight (0.984/lb; 0.971–0.998) and type of procedure (2.16; 2.12–6.38) were confirmed as significant independent variables for postsurgical infections.

Conclusion: Febrile morbidity had limited value as a screening test for postoperative infection, with poor sensitivity and positive predictive value after vaginal surgery.

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