title: Cost and effectiveness of postoperative fever diagnostic evaluation in total joint arthroplasty patients.
abstract: The purpose of this study is to examine the characteristics and costs of postoperative fever diagnostic evaluations after total joint arthroplasty. All patients who underwent hip and knee arthroplasty (n = 1100) at a single institution for a 2-year period were included. Fever (temperature > or = 38.5 degrees C) occurred in 15% of patients. The rate of positive tests was as follows: chest radiograph (2%), blood culture (6%), urine culture (22%), and urinalysis (23.7%). Fever occurring after postoperative day 3 (odds ratio [OR] 23.3; P < .001) and multiple days febrile (OR, 8.6; P = .003) are independent predictors of a positive workup, and patients with a maximum temperature of 39.0 degrees C or higher (25.4% vs 6.9%; P = .001) had a significantly higher rate of positive fever evaluations. The total direct cost associated with fever evaluations was $73 878, and cost per change in clinical management was $8209. Fever is a common occurrence after hip and knee arthroplasty, and many elements of an infectious evaluation are costly and clinically unnecessary.
authors.affiliation: Department of Orthopedic Surgery, University of California, San Francisco, California, USA.
authors.forename: Derek T
authors.initials: DT
authors.lastname: Ward
authors.forename: Erik N
authors.initials: EN
authors.lastname: Hansen
authors.forename: Steven K
authors.initials: SK
authors.lastname: Takemoto
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Bozic
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D003362:Cost-Benefit Analysis; D003955:Diagnostic Tests, Routine / Q000191:economics*; D005260:Female; D005334:Fever / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D006403:Hematologic Tests / Q000191:economics; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D017410:Practice Guidelines as Topic; D013902:Radiography, Thoracic / Q000191:economics; D012189:Retrospective Studies; D016482:Urinalysis / Q000191:economics