Edict of Postoperative Fever and Atelectasis

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In their review and meta-analysis in a recent issue of CHEST (August 2011), Mavros and colleagues1Mavros MN Velmahos GC Falagas ME Atelectasis as a cause of postoperative fever: where is the clinical evidence?.Chest. 2011; 140: 418-424Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar question the historical edict that postoperative fever is caused by atelectasis. The authors found little evidence to support the supposition that an association between fever and atelectasis actually exists. One limitation of the review acknowledged a paucity of data in the medical literature. A total of eight studies were included in their manuscript; however, only two specifically addressed the primary research question of association between atelectasis and fever.2Engoren M Lack of association between atelectasis and fever.Chest. 1995; 107: 81-84Abstract Full Text Full Text PDF PubMed Scopus (66) Google Scholar, 3Pérez-Aispuro I Pérez-Castro J Avelar-Garnica F Wacher-Rodarte N Lifshitz-Guinzberg A A reconsideration of postoperative fever due to pulmonary atelectasis [in Spanish].Gac Med Mex. 1991; 127: 27-30PubMed Google Scholar The first, by Engoren,2Engoren M Lack of association between atelectasis and fever.Chest. 1995; 107: 81-84Abstract Full Text Full Text PDF PubMed Scopus (66) Google Scholar was a blinded, nonrandomized study of 100 adult patients who underwent cardiac surgery that failed to show an association between fever and atelectasis on the first 3 postoperative days. The second study, by Pérez-Aispuro et al,3Pérez-Aispuro I Pérez-Castro J Avelar-Garnica F Wacher-Rodarte N Lifshitz-Guinzberg A A reconsideration of postoperative fever due to pulmonary atelectasis [in Spanish].Gac Med Mex. 1991; 127: 27-30PubMed Google Scholar was also a blinded nonrandomized study of adult patients undergoing abdominal surgery that failed to show an association between postoperative fever and atelectasis. We recently reported on the largest cohort of pediatric patients, to our knowledge, aimed at specifically questioning the association between atelectasis and postoperative fever.4Kane JM Friedman M Mitchell JB Wang D Huang Z Backer CL Association between postoperative fever and atelectasis in pediatric patients.World J Ped and Congenital Heart Surg. 2011; 2: 359-363Crossref PubMed Scopus (9) Google Scholar In our study, 196 pediatric patients underwent analysis for association between postoperative fever and atelectasis. Radiologists were blinded to clinical data, and a radiographic scoring system similar to that of Engoren2Engoren M Lack of association between atelectasis and fever.Chest. 1995; 107: 81-84Abstract Full Text Full Text PDF PubMed Scopus (66) Google Scholar was used. Participants were stratified into groups based on demographic variables to increase the power to detect an association using the Cochran-Mantel-Haenszel test. We found no association between fever atelectasis on any postoperative day. We also found no relationship between the severity of atelectasis and highest daily temperature. Although there are only a limited number of studies specifically addressing the association between atelectasis and postoperative fever, those data that do exist overwhelmingly demonstrate no association. Further, nearly all published studies uniformly recommend that the inclusion of atelectasis as a cause of postoperative fever be discarded as historical conjecture and unsupported dogma. Mavros and colleagues1Mavros MN Velmahos GC Falagas ME Atelectasis as a cause of postoperative fever: where is the clinical evidence?.Chest. 2011; 140: 418-424Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar conclude that there is a need for additional large studies to precisely evaluate whether there is an association that the prior studies have not detected. We respectfully disagree, given the findings of our most recent study. From our perspective, based on our large cohort of patients and the outcome of our study, rather than performing additional studies, it would seem more prudent and appropriate to simply discard old dogma. Edict of Postoperative Fever and Atelectasis: ResponseCHESTVol. 141Issue 1PreviewWe thank Drs Kane and Backer for their correspondence on our recent article, which contributed to the discussion of the potential association between postoperative fever and atelectasis.1 The authors conducted a retrospective cohort study, examining the potential association between postoperative fever and atelectasis in pediatric patients.2 They concluded that no such association existed, and, thus, postoperative fever should not be attributed to atelectasis. Full-Text PDF