Incidence, Risk Factors, and Diagnostic Evaluation of Postoperative Fever in an Orthopaedic Trauma Population

Abstract

To determine the incidence of positive diagnostic evaluations during the management of postoperatively febrile orthopaedic trauma patients. A secondary objective was to describe the incidence and risk factors for postoperative fever. Retrospective study. The orthopaedic trauma service at a tertiary referral hospital. Postoperatively febrile orthopaedic trauma patients admitted from 2005 to 2008. In patients who developed postoperative fever (oral temperature ≥38.5ºC), records were reviewed to determine whether urinalysis, urine cultures, blood cultures, chest radiographs, or wound cultures were performed and subsequent results were recorded. Patient demographics including sex, age, and medical comorbidities were also noted. A total of 106 subjects (18%) developed a postoperative fever, with a mean temperature of 38.8 ± 0.3ºC (range, 38.5-40.0ºC). Overall, 135 diagnostic tests were ordered with 14 being positive (10%). Yields per individual test were as follows: urinalyses, 7 of 34 (21%); urine cultures, 4 of 38 (11%); chest radiograph, 2 of 23 (9%); blood cultures, 1 of 38 (3%); and wound cultures, 0 of 2 (0%). Patients investigated on postoperative day 6 or later had a greater incidence of positive diagnostic evaluations (40%) than patients investigated on postoperative days 0-5 (16%). The single positive blood culture was found on postoperative day 16. Postoperative fever is common among orthopaedic trauma patients. Diagnostic evaluations have a low-positive yield, particularly in the early postoperative period. In the later postoperative period, physicians should be more suspicious for an infective source of fever because a traumatic inflammatory etiology of fever is less likely.