Fever beyond the 4th postoperative day is most indicative of which complication?

Fever beyond the 4th postoperative day is most indicative of which complication?

• A. Postpericardiotomy syndrome
• B. Mediastinitis
• C. Pneumonia
• D. Urinary tract infection

Answer: (B)

Late postoperative fever after CABG is a red flag for a deep sternal wound infection, i.e., mediastinitis. This condition typically emerges after the initial postoperative inflammatory period and presents with persistent fever, chest pain or sternal tenderness, and often wound drainage or mediastinal discomfort. It reflects infection of the mediastinal tissues around the sternum and carries a high risk of sepsis, requiring urgent workup and treatment with IV antibiotics and surgical debridement. Postpericardiotomy syndrome usually appears earlier and brings pericardial symptoms such as chest pain from pericarditis and a friction rub, rather than a deep mediastinal infection. Pneumonia or urinary tract infection can cause fever after surgery, but the combination of fever extending beyond day four with sternotomy site involvement strongly points to mediastinitis.

Late postoperative fever after CABG is a red flag for a deep sternal wound infection, i.e., mediastinitis. This condition typically emerges after the initial postoperative inflammatory period and presents with persistent fever, chest pain or sternal tenderness, and often wound drainage or mediastinal discomfort. It reflects infection of the mediastinal tissues around the sternum and carries a high risk of sepsis, requiring urgent workup and treatment with IV antibiotics and surgical debridement. Postpericardiotomy syndrome usually appears earlier and brings pericardial symptoms such as chest pain from pericarditis and a friction rub, rather than a deep mediastinal infection. Pneumonia or urinary tract infection can cause fever after surgery, but the combination of fever extending beyond day four with sternotomy site involvement strongly points to mediastinitis.