Postoperative Febrile Morbidity After Myomectomy

Definition of febrile morbidity: Variable

Temperature ≥38°c measured at least twice at an interval of at least 6 hours apart, except within the first 24 hours postoperative.

It has also been defined as a body temperature of 38.0 °C or higher, taken by mouth as a standard technique at least four times daily, that occurred in any two consecutive days of the first 10 days postoperative, excluding the first 24 h.

Some authors have also defined febrile morbidity as T= 100.4° F in the first 72 hours after surgery.

Pathophysiology of febrile morbidity:

Febrile morbidity occurs without obvious signs of infection due to either or both of the following:

1. Formation of an intra-myometrial hematoma
2. Release of nonspecific febrile factors from the myoma during dissection

It is often difficult to distinguish infection from fever caused by the release prostaglandins during myomectomy.

Important points related to febrile morbidity:

1. Incidence of febrile morbidity post-myomectomy is approximately one-third (33%)
2. Important risk factors:
   • Overweight
   • Pre- and postoperative anemia
   • Open myomectomy (most strongly associated risk factor)
     • The risk for febrile morbidity in women undergoing abdominal myomectomy is 6.34 times that of laparoscopic myomectomy
     • Might be associated with more extensive manipulation, higher amount of blood loss, and more exposure of visceral abdominal structures.
   • Prolonged operation (>180 minutes)
3. The causes of febrile morbidity cannot be identified in most cases and the fever spontaneously resolves with expectant management.

References:

1. https://www.glowm.com/section-view/heading/Myomectomy/item/40
2. Wattanasiri K, Lattiwongsakorn W, Sreshthaputra RA, Tongsong T. Incidence and Risk Factors of Postoperative Febrile Morbidity among Patients Undergoing Myomectomy. Medicina (Kaunas). 2023 May 20;59(5):990. doi: 10.3390/medicina59050990. PMID: 37241222; PMCID: PMC10223126.
3. D. Vavilis; E. Togaridou; T. Agorastos. (2005). Abdominal myomectomy and febrile morbidity. , 88(1), 0–62. doi:10.1016/j.ijgo.2004.09.021
4. Garg D, Tang N, Homel P. Febrile Morbidity After Robotic versus Abdominal Myomectomy. Journal of Minimally Invasive Gynecology, 23S22

Dr. Pooja Shrestha

Anesthesiology Resident (PGY-1) at Tribhuvan University Teaching Hospital, Institute of Medicine (TUTH, IOM). Her academic interests include perioperative medicine, regional anesthesia, and evidence-based practices in anesthesiology. She contributes scholarly articles on anesthesia to Epomedicine.