CME Topic

Causes and Risk Factors for Postoperative Fever in Spine Surgery Patients

Authors: M Sami Walid MD, PhD, M Neal Woodall BS, Jonathan P. Nutter BS, Mohammed Ajjan MD, Joe Sam Robinson Jr MD, FACS

Abstract

Abstract:Postoperative fever is a common dilemma faced by neurosurgeons. To study this problem, we prospectively collected patients who developed fever after spine surgery during the academic year 2007–2008 for whom the internist's consultation was requested. Eighty-five (85) patients were identified, of which 17 had an identifiable infectious cause for their febrile reaction (20%) – fever was attributed to urinary tract infection in 8 cases, pneumonia in 5 cases, wound infection in 3 cases (all lumbar), and cholecystitis in 1 case. The remaining 68 patients (80%) had no definitive diagnosis and fever was attributed to a peripheral venous line which, in this case, was replaced or discontinued. In 32 (37.6%) of the patients, the fever developed on postoperative day (POD) 2 or later. There was no statistically significant relationship between day of fever appearance and whether the fever was due to definite infection (P = 0.737). Comparing the basic group with another group of 456 spine surgery patients from 2006–2007 who might or might not have developed fever postoperatively using ANOVA, we found a significant difference in age (P = 0.011) and a very significant difference in hemoglobin level (P = 0.000) and HbA1c level (P = 0.000), but not in body mass index (BMI) (P = 0.289). Thus, most of the postoperative fever cases after spine surgery have no identifiable infectious focus and develop mainly in older patients with anemia and inadequately controlled HbA1c. A meticulous investigation of the source of fever including laboratory and radiological studies remains essential. Early mobilization is recommended for individuals undergoing lower spine surgery in order to decrease bacterial contamination from the gluteal cleavage.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

References1. Hospital-acquired and postoperative infections. Available at: http://www.injuryboard.com/topic/nosocomial-postoperative-infections.aspx. Accessed July 15, 2008.2. Schwarzenegger Vetoes Hospital Infection Control Bill. October 5, 2004. Available at: http://www.consumeraffairs.com/news04/ca_hospital_infection.html. Accessed July 15, 2008.3. Dellinger EP. Approach to the patient with postoperative fever, in Gorbach SL, Bartlett JG, Blacklow NR (eds): Infectious Diseases. Philadelphia, PA, Lippincott Williams and Wilkins, 2004, ed 3, pp 817.4. Pile JC. Evaluating postoperative fever: a focused approach. Cleve Clin J Med 2006;73(suppl 1):S62–S66.PileJCEvaluating postoperative fever: a focused approach.Cleve Clin J Med200673S62-S665. Fanning J, Neuhoff RA, Brewer JE, et al. Frequency and yield of postoperative fever evaluation. Infect Dis Obstet Gynecol 1998;6:252–255.FanningJ]]NeuhoffRA]]BrewerJE&etal;Frequency and yield of postoperative fever evaluation.Infect Dis Obstet Gynecol19986252-2556. Shaw JA, Chung R. Febrile response after knee and hip arthroplasty. Clin Orthop Relat Res 1999;367:181–189.ShawJA]]ChungRFebrile response after knee and hip arthroplasty.Clin Orthop Relat Res1999367181-1897. Garibaldi RA, Brodine S, Matsumiya S, et al. Evidence for the non-infectious etiology of early postoperative fever. Infect Control 1985;6:273–277.GaribaldiRA]]BrodineS]]MatsumiyaS&etal;Evidence for the non-infectious etiology of early postoperative fever.Infect Control19856273-2778. Wortel CH, van Deventer SJ, Aarden LA, et al. Interleukin-6 mediates host defense responses induced by abdominal surgery. Surgery 1993;114:564–570.WortelCH]]van DeventerSJ]]AardenLA&etal;Interleukin-6 mediates host defense responses induced by abdominal surgery.Surgery1993114564-5709. Frank SM, Kluger MJ, Kunkel SL. Elevated thermostatic setpoint in postoperative patients. Anesthesiology 2000;93:1426–1431.FrankSM]]KlugerMJ]]KunkelSLElevated thermostatic setpoint in postoperative patients.Anesthesiology2000931426-143110. de la Torre SH, Mandel L, Goff BA. Evaluation of postoperative fever: usefulness and cost-effectiveness of routine workup. Am J Obstet Gynecol 2003;188:1642–1647.de la TorreSH]]MandelL]]GoffBAEvaluation of postoperative fever: usefulness and cost-effectiveness of routine workup.Am J Obstet Gynecol20031881642-164711. Guadagnino C. Pa.'s hospital-acquired infection battle. Physician's News Digest, February 2006. Available at: http://www.physiciansnews.com/cover/206.html. Accessed July 16, 2008.12. Horvath S. Hospital suits settled for $31 million. The Palm Beach Post, December 24, 2004.