••• CHAPTER 35^ Postoperative Care of the Gynecologic Patient^351
❍ What are the causes of fever in the immediate postoperative period?
Medications or blood products given during the perioperative period are the most common cause of early fever.
Other causes may be due to trauma suffered prior to surgery or as part of surgery infections that were present prior
to surgery; and rarely, malignant hyperthermia.
❍ When should blood cultures be obtained on the postoperative febrile patient?
Blood cultures are of little value in immunocompetent patients unless the temperature is > 102 °F.
❍ How should the postoperative patient with costovertebral tenderness and fever be evaluated?
The urine should be examined for evidence of infection. If infection is not evident, then an intravenous pyelogram
should be considered to assess for ureteral damage or obstruction.
❍ Should prophylactic antibiotics be routinely used when patients have indwelling Foley catheters?
Not unless the patient is immunocompromised.
❍ What is the most common postoperative site of infection?
Intravenous catheter-related infections have a reported incidence of 25% to 35%. Urinary tract infections (UTIs)
are much less frequent with the greater use of prophylactic antibiotics.
❍ When should a chest film be performed for the febrile postoperative patient?
In the presence of pulmonary findings or risk factors for pulmonary complications.
❍ How often should intravenous catheters be changed?
Every 72 hours, after which time the risk of catheter-related phlebitis increases greatly.
❍ What is the relationship between preoperative shaving and wound infection?
Preoperative shaving increases the rate of wound infection.
❍ Does vaginal cuff cellulitis need antibiotics?
It is present to some extent in most patients who have undergone hysterectomy, and is usually self-limited.
However, when fever, leukocytosis, and pelvic pain are present, antibiotics are indicated.
❍ What are the most common bacteria isolated from pelvic abscesses in the postoperative patient?
They are most often polymicrobial including Escherichia coli, Klebsiella, and Bacteroides species.
❍ What tissues are involved in necrotizing fasciitis?
The dermis and subcutaneous tissue with necrosis of the superficial fascia, without muscle involvement.
❍ What are predisposing factors to the development of necrotizing fasciitis?
Diabetes mellitus, trauma, alcoholism, immunocompromised state, hypertension, peripheral vascular disease,
intravenous drug use, and obesity.
❍ What is the primary treatment of necrotizing fasciitis?
Extensive surgical debridement down to the fascia.