A 65-year-old male underwent open total colectomy 3 days ago. He now develops fever (38.6 degrees Celsius), tachypnea, and decreased breath sounds at both lung bases with dullness to percussion. What is the most common cause of early postoperative fever on days 1 to 3?

Answer and explanation

Correct answer: C. Atelectasis and postoperative pneumonia

  1. Step 1: Recall the surgical mnemonic for postoperative fever: Wind (days 1-2: atelectasis), Water (day 3: UTI), Wound (days 5-7: surgical site infection), Walking (days 7-10: DVT/PE), Wonder drugs (anytime).
  2. Step 2: Atelectasis secondary to shallow breathing from incision pain, anesthesia, and opiate analgesia is the most frequent cause in the first 48-72 hours.
Answer
Atelectasis and postoperative pneumonia.
Why not the others: 'Deep vein thrombosis with pulmonary embolism' typically manifests later around days 7-10 post-op; 'Surgical site wound infection' typically presents on postoperative days 5 to 7 with erythema and purulence; 'Catheter-associated urinary tract infection' peaks around day 3 but is less common than pulmonary atelectasis in major abdominal laparotomies.

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