Postoperative Fever in Pediatric Orthopaedic Patients

Jd, Angel; Rd, Blasier; Allison, R.

doi:10.1097/01241398-199414060-00021

Cited by 23 publications

(14 citation statements)

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“…have been impressed by the relatively large volume of calls from anesthesiologists seeking advice on the possibility of MH in patients with postoperative fever. Although numerous publications attest to the fact that postoperative fever is common [2][3][4][5][6][7][8] and not caused by MH, 9 we believe that many anesthesiologists are under the impression that the onset of MH may be delayed well into the postoperative period. Therefore, we undertook this analysis of the NAMHR to further understand the incidence of postoperative MH and its clinical characteristics.…”

Section: Discussionmentioning

confidence: 94%

Postoperative Malignant Hyperthermia

et al. 2008

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Section: Discussionmentioning

confidence: 94%

Postoperative Malignant Hyperthermia

et al. 2008

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“…Previous studies have shown that the positive rate of a routine diagnostic workup is as low as 2.4-14.8%. 3,19,22,23 BC yielded a very low percentage of 21 …”

Section: Discussionmentioning

confidence: 99%

Post-operative fever in orthopaedic surgery: How effective is the ‘fever workup?’

Ashley

Spiegel

Cahill

et al. 2017

Journal of Orthopaedic Surgery

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Background: Defining the appropriate threshold at which to initiate a fever workup is imperative to promote patient safety, appropriate resource utilization, and antibiotic stewardship. Our group performed a systematic review of the available literature on perioperative fever (POF) workups in orthopaedic patients to evaluate the frequency, timing and utility of blood cultures (BC) and other investigations in the POF workup, to determine the clinical relevance of any infections and to evaluate their cost effectiveness. Methods: Studies were identified by searching MEDLINE, EMBASE, Pubmed, Cochrane and Google Scholar for articles through September 2016. Forty-nine articles were retrieved and 22 articles met the pre-determined inclusion criteria. Proportions of positive studies were noted and averaged using random effects analysis. Results: Post-operative pyrexia ranged in prevalence between 8.1% and 87.3%. The studies routinely performed during a fever workup had wide ranges of diagnostic yield, including chest X-rays from 0% to 40%, urinalyses from 8.2% to 38.7%, urine cultures from 0% to 22.4% and BC from 0% to 13.3%. Only two patients with positive BC developed clinical sepsis. Cost per fever evaluation ranged from $350 to $950. Conclusion: The findings of this review suggest that early post-operative fever is an expected event following orthopaedic surgery. Based on the available literature, any kind of workup in the absence of localizing symptoms in the third post-operative day or before is unwarranted and is an inappropriate use of hospital resources.

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“…Postoperative fever is a common occurrence following both general and orthopedic surgical procedures, with a reported incidence between 10% and 73% [ 1 - 5 ]. Postoperative complications such as urinary tract infection (UTI), sepsis, pneumonia (PNA), surgical site infection (SSI), deep vein thrombosis (DVT), and pulmonary embolism (PE) may result in pyrexia [ 6 - 9 ].…”

Section: Introductionmentioning

confidence: 99%

Postoperative Fever Evaluation Following Lumbar Fusion Procedures

et al. 2018

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ObjectiveThis study aimed to determine the incidence of postoperative fever, the workup conducted for postoperative fever, the rate of subsequent fever-related diagnoses or complications, and the risk factors associated with fever following lumbar fusion.MethodsA retrospective review of patients undergoing lumbar fusion was performed. For patients in whom fever (≥38.6°C) was documented, charts were reviewed for any fever workup or diagnosis. Multivariate regression was used to identify independent risk factors for the development of postoperative fever. ResultsA total of 868 patients met the inclusion criteria, of whom 105 exhibited at least 1 episode of fever during hospitalization. The first documentation of fever occurred during the first 24 hours in 43.8% of cases, during postoperative hours 24–48 in 53.3%, and later than 48 hours postoperatively in 2.9%. At least 1 component of a fever workup was conducted in 47 of the 105 patients who had fever, resulting in fever-associated diagnoses in 4 patients prior to discharge. Three patients who had fever during the inpatient stay developed complications after discharge. On multivariate analysis, operations longer than 150 minutes (relative risk [RR], 1.66; p=0.015) and narcotic consumption greater than 85 oral morphine equivalents on postoperative day 0 (RR, 1.53; p=0.038) were independently associated with an increased risk of developing postoperative fever. ConclusionThe results of this study suggest that inpatient fever occurred in roughly 1 in 8 patients following lumbar fusion surgery. In most cases where a fever workup was performed, no cause of fever was detected. Longer operative time and increased early postoperative narcotic use may increase the risk of developing postoperative fever.

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Postoperative Fever in Pediatric Orthopaedic Patients

Cited by 23 publications

References 0 publications

Postoperative Malignant Hyperthermia

Postoperative Malignant Hyperthermia

Post-operative fever in orthopaedic surgery: How effective is the ‘fever workup?’

Postoperative Fever Evaluation Following Lumbar Fusion Procedures

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