Open any surgical textbook or ask most surgeons and you will find that fever within the first 3 or 4 days after any major operation will most commonly be ascribed to atelectasis [the partial collapse of one or both lungs, usually due to pain-induced hypoventilation].
Some authors have questioned this dogma and now a systematic literature review published ahead of print in the journal, Chest, confirms that atelectasis and fever are not associated.
The authors reviewed well over 300 papers and found 8 which addressed the issue. Nearly 1000 patients were included. Of the 8 papers, 7 reported no link between the presence of fever and atelectasis. Due to heterogeneity of the studies, a formal meta-analysis could not be done.
The authors stated, “In conclusion, there is no clinical evidence suggesting that atelectasis is a major cause of EPF [early postoperative fever]. The rather limited evidence implies that atelectasis may be not associated with fever at all.”
Fever in the early postoperative period is likely due to an inflammatory response generated by the stress and trauma of surgery and anesthesia. It is a benign, self-limiting phenomenon and does not require intervention.
Like many long-held ideas, the belief that “atelectasis causes fever” will be difficult to change. I asked the authors what measures could be taken to enhance the awareness of surgeons about this important subject. The senior author, George C. Velmahos, MD, PhD, MSEd and John F. Burke Professor of Surgery at Harvard Medical School, feels that change might be prompted by “…by giving lectures and maybe designing a prospective multi-center study.”
Meanwhile, we will spread the word one blog reader at a time.