Walid M Sami, Woodall M Neal, Nutter Jonathan P, Ajjan Mohammed, Robinson Joe Sam
Department of Education and Research, Medical Center of Central Georgia, Macon, GA, USA.
South Med J. 2009 Mar;102(3):283-6. doi: 10.1097/SMJ.0b013e31819676a4.
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.
术后发热是神经外科医生常面临的一个难题。为研究这一问题，我们前瞻性地收集了2007 - 2008学年脊柱手术后出现发热且被要求内科会诊的患者。共确定了85例患者，其中17例（20%）发热反应有明确的感染原因——8例发热归因于尿路感染，5例归因于肺炎，3例（均为腰椎手术）归因于伤口感染，1例归因于胆囊炎。其余68例患者（80%）没有明确诊断，发热归因于外周静脉置管，在这种情况下，更换或拔除了静脉置管。32例（37.6%）患者在术后第2天或更晚出现发热。发热出现的日期与发热是否由明确感染引起之间无统计学显著关系（P = 0.737）。使用方差分析将该基础组与2006 - 2007年另一组456例脊柱手术患者（这些患者术后可能发热也可能未发热）进行比较，我们发现年龄有显著差异（P = 0.011），血红蛋白水平（P = 0.000）和糖化血红蛋白水平（P = 0.000）有非常显著差异，但体重指数（BMI）无差异（P = 0.289）。因此，脊柱手术后的大多数术后发热病例没有可识别的感染病灶，主要发生在贫血且糖化血红蛋白控制不佳的老年患者中。对发热来源进行细致调查，包括实验室检查和影像学检查，仍然至关重要。建议接受下脊柱手术的患者尽早活动，以减少臀沟处的细菌污染。
