Fever Burden After Liver Surgery: From Infection Diagnostics to Phenotyping of the Immunometabolic Response

The concept of “fever burden” represents a quantitative and dynamic expression of the host immunometabolic response, integrating the duration, intensity, and temporal characteristics of postoperative temperature alterations. This review discusses the biological rationale underlying postoperative fever and explores its potential clinical relevance in the context of liver surgery, particularly in distinguishing infectious complications from sterile postoperative inflammation. This narrative review was based on a structured literature search of PubMed and Embase (2000–2025) to identify clinical and translational studies addressing postoperative fever after hepatic resection and liver transplantation. The retrieved literature was narratively synthesized with emphasis on fever burden, temperature trajectories, and biologically plausible mechanisms potentially associated with postoperative recovery and infectious complications. Current evidence suggests that postoperative fever may reflect dynamic activation of innate immune and inflammatory pathways rather than representing a purely binary sign of infection. In liver surgery, clinically relevant information may be better captured by temporal fever characteristics, including timing of fever onset, peak temperature, and recurrent febrile episodes, than by isolated temperature measurements alone. However, direct liver-surgery-specific evidence remains limited, and broader concepts related to temperature trajectories and immunometabolic phenotyping should currently be regarded as hypothesis-generating. Fever burden and temperature trajectory analysis may therefore represent promising conceptual approaches for interpreting postoperative host-response patterns after liver surgery, although their diagnostic and prognostic value requires prospective validation in liver-specific clinical cohorts.