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Post-operative fever (POF) after cardiac surgery in a low- and middle-income-country: 7-year institutional experience

Published online by Cambridge University Press:  09 February 2021

Ikechukwu A Nwafor Open the ORCID record for Ikechukwu A Nwafor [Opens in a new window]  and
John C. Eze
Ikechukwu A Nwafor*
Affiliation:
Faculty of Medical Sciences, University of Nigeria, Ituku-Ozalla Campus & National cardiothoracic Center of Excellence, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
John C. Eze
Affiliation:
Faculty of Medical Sciences, University of Nigeria, Ituku-Ozalla Campus & National cardiothoracic Center of Excellence, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
*
Author for correspondence: Dr Nwafor, IA. Department of Surgery, UNTH/NCTCE, Ituku-Ozalla, Enugu, Nigeria. Tel: +2348037784860. E-mail: Igbochinanya2@yahoo.com, ikechukwu.nwafor@unn.edu.ng
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Abstract

Background:

Post-operative fever (POF) after cardiac surgery in a developing country is of great concern because of the associated morbidity and mortality. In our country, we experience this complication more because of a high rate of malaria infestations, gastroenteritis, and malnutrition. We also experience a low yield of positive diagnostic tests when POF develops; this is partly due to expense and the prioritisation of other essential items in our poorly equipped cardiac ICU.

Aims/Objective:

To assess the causes of POF after cardiac surgery and determine its impact on the outcome on patients.

Materials and methods:

International Cardiac Surgery Mission teams visited our centre for 7 years (2013–2019). During this period, a significant number of cardiac surgeries were performed. A retrospective study of patients with POF was performed with data from our hospital’s database, and included standard demographics; types of surgery performed, and management protocols being used in the peri-operative care.

Results:

A total of 242 patients were treated during the study period and underwent 266 surgeries. Of these, 151 (56.8%) and 115 (43.2%) were adult and paediatric cases respectively. Ages ranged between 0 and 90 years; 34 (14.1%) had POF. When we evaluated the clinical and associated laboratory findings, pyrexia (temp >38.0 °C) and elevated white blood cell count with differential neutrophilia were present in 10 patients (29.4%). The time of onset and duration of POF were between <24 and >144 hours. In the invasive procedure related to POF, sternotomy infections were present in seven patients (18.4%). Malaria infestations and breach in sterility protocol were predominant.

Conclusion:

The management of POF in the cardiac ICU was complicated by the requirement of co-operation from a larger number of specialties than is usually required in advanced centres with special expertise in malaria confirmation. We, therefore, introduced structured clinical, laboratory, and appropriate interventions to treat POF more aggressively. We found that more careful attention to peri-operative details to ensure strict observation of sterility protocol with anti-malaria prophylaxis led to improvements in our centre’s outcomes.

Keywords

Cardiac surgerypost-operativefeverinfectiousnon-infectious
Type
Review
Information
Cardiology in the Young , Volume 31 , Issue 3 , March 2021 , pp. 352 - 357
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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