Blood cultures in febrile patients after hysterectomy. Cost-effectiveness.

Abstract

OBJECTIVE To determine the impact and cost-effectiveness of blood cultures in patients with febrile morbidity following vaginal or abdominal hysterectomy. STUDY DESIGN The charts of 192 abdominal and 150 vaginal hysterectomy cases performed at Walter Reed Army Medical Center for benign disease between June 1992 and June 1995 were retrospectively analyzed for postoperative febrile morbidity, fever evaluation, blood culture results, management and clinical course. RESULTS Of the 342 hysterectomy cases reviewed, 46 (24%) abdominal and 16 (10.7%) vaginal hysterectomies had fever evaluations that included aerobic and anaerobic blood cultures. There were no blood cultures documenting bacteremia in the abdominal or vaginal hysterectomy patients evaluated for postoperative febrile morbidity. Two patients with positive blood cultures had preoperative infections and were eliminated from statistical analysis. Adherence to the definition of febrile morbidity eliminated another 19 (30.6%) of the 62 febrile patients phlebotomized for blood cultures. CONCLUSION Blood cultures in the routine patient following vaginal or abdominal hysterectomy did not alter management and were not cost-effective. Blood cultures may be appropriate for febrile patients with preoperative, intraoperative and postoperative risk factors for bacteremia.