Postoperative fever discharge guidelines increase hospital charges associated with spine surgery.
BACKGROUND
Postoperative fever is a common sequel of spine surgery. In the presence of rigid nationally mandated clinical guidelines, fever management may consume more health care resources than is reasonably appropriate.


OBJECTIVE
To study the relationship between postoperative fever, infection rate, and hospital charges in a cohort of spine surgery patients.


METHODS
We retrospectively reviewed 578 spine surgery patients (lumbar microdiskectomy [LMD], anterior cervical decompression and fusion [ACDF], and lumbar decompression and fusion [LDF]). Differences in length of stay and hospital charges as well as risk factors and correlation with infection and readmission rates were studied.


RESULTS
Postoperative fever occurred in 41.7% of all spine surgery patients and more often in LDF patients (77.2%). Type of surgery was the most important variable affecting the prevalence of postoperative fever. Significant differences in length of stay were elicited between patients with and without postoperative fever in the ACDF and LMD groups and in hospital cost in the LMD group. The average length of stay was 2.41 vs 4.47 (P < .01) in the LMD group, 1.67 vs 2.80 (P < .05) in the ACDF group, and 5.03 vs 5.65 (P > .05) in the LDF group. The average hospital charges were $16 261 vs $22 166 (P < .01) in the LMD group, $26 021 vs $29 125 (P > .05) in the ACDF group, and $53 627 vs $53 210 (P > .05) in the LDF group. Obesity, female sex, and ≥102°F postoperative temperature were the most significant predictors of infection. Delayed discharge referable to postoperative fever did not seem to influence the infection readmission rate.


CONCLUSIONS
Postoperative fever in spine surgery patients is associated with a delay in patient discharge and increases in hospital charges. Postoperative fever discharge guidelines should be regularly and publicly subjected to appropriate cost-benefit analysis.
Department of Medical Education and Research, Medical Center of Central Georgia, Macon, Georgia 31201, USA. mswalid@yahoo.com
M Sami
MS
Walid
Gulnur
G
Sahiner
Cemre
C
Robinson
Joe Sam
JS
Robinson
Mohammed
M
Ajjan
Joe Sam
JS
Robinson
D015331:Cohort Studies; D005260:Female; D005334:Fever / Q000191:economics* / Q000209:etiology / Q000628:therapy; D017722:Hospital Charges; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000191:economics*; D010351:Patient Discharge / Q000191:economics* / Q000592:standards; D011183:Postoperative Complications / Q000191:economics* / Q000209:etiology / Q000628:therapy; D017410:Practice Guidelines as Topic / Q000592:standards; D012189:Retrospective Studies; D012307:Risk Factors; D013122:Spinal Diseases / Q000191:economics* / Q000601:surgery*