The CREST study highlighted the observation that many patients with postoperative fever had no obvious source of infection. Garibaldi used the term "unexplained fever" to describe this clinical entity. In patients undergoing AH, 32.3% had post operative fever, and in 16.8% of patients there was no obvious source. In patients undergoing VH, 15.3% had postoperative fever, and in 7.2% the source was unknown. Other studies have confirmed that approximately half of all postoperative fevers after VH and AH have no identifiable source.
Unexplained fever is reported less frequently in patients undergoing LH as opposed to traditional hysterectomy. One review reported an incidence of unexplained fever at 2.7%. This apparent advantage has been attributed to the following: (1) the ability to take a second look at the operative field and irrigate the operative field before removing the laparoscope, (2) improved hemostasis because of the positive pressure of CO2 gas, (3) adiminished need for postoperative analgesia, resulting in early ambulation and therefore less atelectasis, and (1) an earlier discharge to home, where fever may go unnoticed and unreported.
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