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Occurrence of fever in the first postoperative week does not help to diagnose infection in clean orthopaedic surgery

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Abstract

Postoperative fever is often misinterpreted as a sign of infection, especially when occurring after the third postoperative day. We assessed the epidemiology of postoperative fever in adult orthopaedic patients and its association with infection. Among 1,073 patients participating in a prospective observational study, 198 (19%) had a postoperative fever (>38°C). Thirteen patients (1.2%) had a surgical site infection and 78 patients (7.3%) had remote bacterial infections during their hospital stay. Including asymptomatic bacteriuria, 174 patients were given antibiotic therapy for a median duration of six days. In multivariate analysis, no clinical parameter was associated with fever, including haematoma (odds ratio 0.9, 95%CI 0.6–1.3), infection (1.6, 0.7–3.7), or antibiotic use (1.6, 0.9–3.0). The maximum temperature on each of the first seven postoperative days did not differ between infected and uninfected patients (Wilcoxon rank-sum tests; p > 0.10). We conclude that fever, even up to the seventh postoperative day, is not substantially helpful to distinguish infection from general inflammation in clean orthopaedic surgery.

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Acknowledgments

We thank Dr. Sadowski for his invaluable help in conducting the study.

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Authors and Affiliations

  1. Orthopaedic Surgery Service, Geneva University Hospitals & Medical School, 4, Rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland

    Ilker Uçkay, Americo Agostinho, Richard Stern, Louis Bernard, Pierre Hoffmeyer & Blaise Wyssa

  2. Division of Infectious Diseases, Bretionneau Hospital, University Hospitals of Tours, Tours, France

    Louis Bernard

Authors
  1. Ilker Uçkay
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  2. Americo Agostinho
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  3. Richard Stern
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  4. Louis Bernard
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  5. Pierre Hoffmeyer
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  6. Blaise Wyssa
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Corresponding author

Correspondence to Ilker Uçkay.

Additional information

All authors received no financial support, grants, or royalties and have no financial interests that could lead to a conflict of interest. All authors state that they have read and approved the manuscript. It has not been published elsewhere nor is it under consideration for publication elsewhere. Parts of the manuscript were presented at the 20th Conference of the European Wound Management Association, Geneva, on June 27, 2010 and at the annual meeting of the Swiss Society for Infectious Diseases, Lausanne, on September 3, 2010, Poster P128.

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Uçkay, I., Agostinho, A., Stern, R. et al. Occurrence of fever in the first postoperative week does not help to diagnose infection in clean orthopaedic surgery. International Orthopaedics (SICOT) 35, 1257–1260 (2011). https://doi.org/10.1007/s00264-010-1128-z

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  • DOI: https://doi.org/10.1007/s00264-010-1128-z

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