Background: To develop a standardized protocol for management of postoperative fever in gynecology patients to decrease unnecessary diagnostic workups and empiric use of antibiotics. Study Design: A prospective analysis of postoperative gynecology patients identified those who experienced fever (maximum temperature [Tmax] > 100.4°F). Patients were triaged into low- and high-risk groups. High-risk patients were managed independent of the protocol. High-risk criteria included bowel operation, preoperative infection, immunodeficiency, indwelling vascular access, mechanical heart valves, and intensive care unit admissions. Low-risk patients were treated with observation and antipyretics. Patients with persistent or high fever, defined as Tmax > 101°F for > 48 hours, were evaluated and treated based on physical examination findings. Results: We evaluated 292 postoperative patients. Forty-seven percent of patients had a final diagnosis of malignancy. Sixty-four patients were high-risk and 33% of these patients experienced fever. Using the standardized protocol, 228 low-risk patients were managed. Thirty-seven of the 228 patients (16%) had fever postoperatively. Nineteen patients had low-grade fever (100.4 to 101°F); none of these patients required antibiotics. Seventeen patients had fever (101.1 to 102°F) and one patient had fever > 102°F. Using the protocol, 6 of 37 patients (16%) were treated with antibiotics for an infectious diagnosis. Conclusions: Although postoperative fever is common in gynecologic patients, the incidence of infection is low (3%). A standardized postoperative fever protocol in low-risk gynecology patients decreases use of empiric antibiotics without compromising morbidity. © 2008 American College of Surgeons.
