Characteristics, risk factors, and infection-related associations of postoperative fever in patients with prostate cancer undergoing minimally invasive radical prostatectomy

Fever is a familiar companion to recovery, a signal that the body is mobilizing its defenses after an injury or an operation. In the context of surgery, this rise in temperature is often a normal reaction to the physical trauma of the procedure itself, a temporary surge of inflammatory chemicals released as tissues heal. However, when a fever persists or spikes unexpectedly, it can be a warning sign of something more serious, such as an infection taking hold in a wound or an internal organ. For patients undergoing surgery to remove the prostate, a gland located deep in the pelvis that produces fluid for semen, distinguishing between a routine healing response and a dangerous infection is a critical task for doctors. Prostate cancer is a common condition for men, and while modern surgical techniques have made the operation less invasive and safer than in the past, the risk of postoperative complications remains a central concern for medical teams. Understanding exactly why some patients develop fevers and what those fevers tell us about their recovery is essential for improving care and ensuring that patients return to health without unnecessary setbacks.

A team of researchers at Beijing Friendship Hospital set out to investigate this specific puzzle among men who had undergone minimally invasive radical prostatectomy, a surgical approach that uses small incisions and specialized instruments to remove the prostate. They looked back at the medical records of 600 men who had this procedure between late 2021 and late 2025. The team defined a postoperative fever as an axillary temperature reaching 38.0 degrees Celsius or higher within 30 days of the surgery. Their goal was not just to count how many men got fevers, but to map out the patterns of those fevers and determine which ones were linked to actual infections versus which were simply part of the body's natural healing process. They examined the timing of the fever, how high the temperature climbed, whether it happened in a single spike or repeated waves, and how long it lasted. By cross-referencing these fever patterns with the patients' medical histories and the results of diagnostic tests, the researchers sought to identify clear warning signs that could help doctors decide when to treat a patient for an infection and when to simply monitor them.

The study found that 75 of the 600 patients, representing 12.5 percent of the group, experienced a fever within the month following their surgery. Among those who did get febrile, the patterns varied significantly. Most men had a single spike in temperature, but nearly 30 percent experienced multiple fever spikes. About a quarter of the febrile patients reached a high temperature of 39.0 degrees Celsius or more. The timing of the peak temperature was particularly revealing: while some fevers occurred in the first three days after surgery, more than half of the patients reached their highest temperature between the fourth and thirtieth day. The researchers also noted that a small group of patients suffered from consecutive fevers that lasted for three days or longer. When they investigated the cause of these fevers, they found that roughly 41 percent of the febrile patients had a confirmed infection. The most common type of infection was a urinary tract infection, which makes sense given that the surgery involves the urinary system and requires a catheter to be left in place during healing. Other infections included respiratory issues and surgical site infections, but these were less frequent.

The researchers then dug deeper to understand what made certain patients more likely to develop a fever in the first place. They compared the medical profiles of the men who got fevers with those who did not. They discovered that patients who had lower levels of albumin, a protein in the blood that helps maintain fluid balance and supports the immune system, were significantly more likely to develop a fever. Similarly, men who had a poorer overall physical health status before surgery, as measured by a standard classification system used by anesthesiologists, faced a higher risk. The presence of complications during or immediately after the surgery was another strong predictor, as was a hospital stay that extended beyond seven days. These factors suggested that a patient's general resilience and the smoothness of their surgical experience were key determinants in whether they would experience a postoperative fever. The study confirmed that these four factors—low albumin, poor preoperative health, surgical complications, and a long hospital stay—were independent predictors, meaning they each contributed to the risk on their own, regardless of the other variables.

Perhaps the most actionable finding for clinical practice was the link between the timing of the fever and the likelihood of infection. The data showed that if a patient's highest temperature occurred between the fourth and thirtieth day after surgery, they were at a significantly increased risk of having an underlying infection. In contrast, fevers that appeared very early, within the first three days, were less likely to be caused by an infection and more likely to be a reaction to the surgical trauma itself. This distinction is vital because it helps doctors avoid unnecessary treatments. If a fever appears early and follows a simple pattern, it may resolve on its own without the need for antibiotics. However, if a fever spikes later in the recovery period, or if it is accompanied by multiple spikes, a very high temperature, or a continuous duration, it strongly suggests an infection that requires medical intervention. In the study, more than half of the patients with confirmed infections were switched to stronger antibiotics, highlighting how these fever patterns guide treatment decisions in real-world practice.

The researchers acknowledged that their study had limitations, as it was a retrospective review of past records rather than a forward-looking experiment, and the specific causes of fever in some cases remained unclear. However, the large number of patients and the consistent surgical techniques used provided a solid foundation for their conclusions. They emphasized that while minimally invasive surgery has reduced the overall trauma and complication rates compared to older open surgical methods, fever remains a common occurrence that requires careful attention. By identifying the specific characteristics of a fever that signal an infection, particularly the timing of the peak temperature, medical teams can better tailor their approach to patient care. This study provides a clearer roadmap for distinguishing between the normal, self-limiting heat of healing and the dangerous warmth of an infection, ultimately helping to ensure that patients recovering from prostate cancer surgery receive the right care at the right time.