Early Outcome of Postoperative Pyrexia Following Major Surgery in Mulago Hospital

Background: This study was undertaken with the main objectives of determining the incidence, the associated factors and the early outcome of postoperative pyrexia and documenting the use of perioperative antibiotic therapy in the elective major surgical patient.
Methods: This was a 5months prospective study carried out in the surgical wards of Mulago Hospital in Uganda. The study variables including socio-demographic characteristics, type of surgery, surgical approach and procedure, operative diagnosis, use of antibiotics, operative wound, and usage of drains, blood transfusion and preoperative stay were recorded in 168 patients undergoing elective major surgery. Six hourly body temperatures were recorded and all patients were daily reviewed for infections and malaria. Laboratory investigations were clinically oriented.
Results: Postoperative pyrexia occurred in 13.7% of patients undergoing elective major surgery. Malignancy, intestinal resection and anastomosis, urinary catheterization, nasogastric tube, intraoperative blood transfusion and prophylactic antibiotics were significantly associated with postoperative pyrexia (p<0.05). Surgical site infection, chest infection, urinary tract infection and malaria were the major causes of postoperative pyrexia. Prophylactic antibiotics were used in 16.7% of the patients whereas liberal postoperative antibiotic prescription was done in 93.5% for an average duration of 5 days. Postoperative pyrexia significantly increased the length of hospital stay (p=0.016).
Conclusion: Infections and malaria are important causes of postoperative pyrexia. All pyrexial patients should be investigated for malaria. There is a need for a policy regarding the use of perioperative antibiotics in Mulago hospital.