“Wind, Water, Wound, Walk, Wonder Drugs”
Post-Op Day | Mnemonic | Cause | Key Clues / Examples | Typical Management |
POD 0 | - | - malignant hyperthermia | volatile anesthetic use, succinylcholine | intra-operatively or within first-hour post-anesthesia but may recur within 24h |
POD 1–2 | 🌬 Wind | 1) Atelectasis → Pneumonia 2) Trauma-related inflammation | Shallow breathing from pain, anesthesia, immobility → hypoventilation, fever, mild hypoxia | Incentive spirometry, ambulation, pulmonary toilet; if pneumonia suspected → CXR, sputum culture, antibiotics expectant |
POD 3–5 | 💧 Water | Urinary Tract Infection (UTI) | Foley catheter use or urinary stasis; dysuria, frequency, positive nitrite or leukocyte esterase | Urinalysis, urine culture → antibiotics; remove catheter early |
POD 5–7 | 🩹 Wound | Surgical site infection (superficial or deep) | Local erythema, warmth, tenderness, pus; may have leukocytosis | Wound inspection, drainage, antibiotics |
POD 5–10 | 🚶 Walk | Deep Vein Thrombosis (DVT) / Pulmonary Embolism (PE) | Immobility, calf pain/swelling, tachycardia, dyspnea | Doppler US, anticoagulation; DVT prophylaxis |
POD 7–10+ | 💊 Wonder Drugs | Drug fever or abscess | Drug reaction (antibiotics, heparin, etc.) or late deep abscess | Discontinue suspect meds, CT scan if abscess suspected, drainage if needed |
ㅤ | ETIOLOGY | NOTES |
POD 0 | ㅤ | ㅤ |
POD 1-2 | - atelectasis / PNA - trauma-related inflammation | ㅤ |
POD 3-5 | UTI | ㅤ |
POD 5-6 | DVT | ㅤ |
POD 7 | Incision site | ㅤ |
POD 8-15 | Deep abscess | ㅤ |
While these early fevers have been classically attributed to atelectesis a more contemporary view is that fevers in the first two days of surgery are due to trauma-related inflammation (Pile, 2006). It is fairly uncommon for patients to present with an infectious fever before post-operative day 2. Urinary tract infections might be diagnosed as early as post-operative day 2, while wound infections and cerebritis would be unlikely to present before post-operative day 4. Malignant hyperthermia rarely presents more than 6 hours after administration of inhaled anesthetics or succinylcholine. `
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