Mayo Benjamin C, Haws Brittany E, Bohl Daniel D, Louie Philip K, Hijji Fady Y, Narain Ankur S, Massel Dustin H, Khechen Benjamin, Singh Kern
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
Neurospine. 2018 Jun;15(2):154-162. doi: 10.14245/ns.1836026.013. Epub 2018 Jun 19.
This 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.
A 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.
A 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.
The 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.
本研究旨在确定腰椎融合术后发热的发生率、针对术后发热所进行的检查、后续与发热相关的诊断或并发症发生率，以及腰椎融合术后发热的相关危险因素。
对接受腰椎融合术的患者进行回顾性研究。对于有发热记录（≥38.6°C）的患者，查阅病历以了解任何发热检查或诊断情况。采用多因素回归分析确定术后发热发生的独立危险因素。
共有868例患者符合纳入标准，其中105例在住院期间至少出现1次发热。43.8%的病例发热首次记录于术后24小时内，53.3%发生在术后24 - 48小时，2.9%发生在术后48小时以后。105例发热患者中有47例至少进行了一项发热检查，4例在出院前得出与发热相关的诊断。3例住院期间发热的患者出院后出现并发症。多因素分析显示，手术时间超过150分钟（相对危险度[RR]，1.66；p = 0.015）以及术后第0天的麻醉药物用量大于85口服吗啡当量（RR，1.53；p = 0.038）与术后发热风险增加独立相关。
本研究结果表明，腰椎融合术后约八分之一的患者会出现住院期间发热。在大多数进行了发热检查的病例中，未检测到发热原因。手术时间延长和术后早期麻醉药物使用增加可能会增加术后发热的风险。
