Blood cultures for evaluation of fever after total joint arthroplasty.
Fever after total joint arthroplasty (TJA) is common. Fearing the potential complications of bacteremia, physicians often obtain blood cultures to evaluate fever after TJA. In this study, we retrospectively examined the results of 102 sets (204 samples) of blood cultures that had been obtained from 50 patients (mean age, 67.3 years) during the first 2 postoperative days for evaluation of fever of 38.3 degrees C or higher. All patients had been receiving antibiotic prophylaxis. Of the 50 patients, 39 had undergone total knee arthroplasty, and 11 had undergone total hip arthroplasty. There had been 49 primary operations and 1 revision. Of the 204 blood culture samples, none had grown a pathogen. The cultures had been ordered by both surgical (61%) and medical (39%) services. The 2008 institution charge to process the 2 blood culture samples (1 set) routinely collected for each evaluation was $120 (true cost, $44.29). Therefore, in the current healthcare market, the charge to the payer for processing 102 sets would be $12,240. We conclude that blood cultures are neither useful nor cost-effective in evaluating fever immediately after TJA. We believe that the results of this study will be helpful to both orthopedists and medical consultants involved in the care of TJA patients.
Anderson
John T
JT
Department of Orthopaedic Surgery, University of Missouri-Kansas City School of Medicine, Children's Mercy Hospital, Kansas City, Missouri, USA. jtanderson@cmh.edu
Osland
John D
JD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000191:economics; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000191:economics; D001431:Bacteriological Techniques / Q000191:economics; D003362:Cost-Benefit Analysis; D005260:Female; D005334:Fever / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis* / Q000382:microbiology; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies