title: Fever is common postoperatively following posterior spinal fusion: infection is an uncommon cause.
abstract: OBJECTIVE
  To determine the frequency and clinical significance of postoperative fever in pediatric patients undergoing posterior spinal fusion (PSF).
  
  
  METHODS
  A retrospective chart review was performed for consecutive patients undergoing PSF at a single institution between June 2005 and April 2011, with a minimum of 2-year follow up. Exclusion criteria were previous spine surgery, a combined anterior-posterior approach, and delayed wound closure at the time of surgery.
  
  
  RESULTS
  Two hundred and seventy-eight patients with an average age of 13 years (1-22 years) met inclusion criteria, with the following diagnoses: adolescent idiopathic scoliosis 43%, neuromuscular/syndromic scoliosis 39%, congenital scoliosis 11%, spondylolisthesis 4%, and Scheuermann kyphosis 3%. Seventy-two percent (201/278) of patients had a maximum temperature (Tmax) >38(°) postoperatively, and 9% (27/278) Tmax >39(°). The percentage of febrile patients trended down following the first postoperative day. Infection rate was 4% (12/278). There was no correlation between Tmax >38(°) or Tmax >39(°), and timing of fever, positive blood or urine cultures, pneumonia, or surgical site infection.
  
  
  CONCLUSIONS
  Seventy-two percent of pediatric patients undergoing PSF experienced postoperative fever, and 9% of patients had Tmax>39(°). There was no significant correlation between fever and positive blood culture, urine culture, pneumonia, or surgical site infection. This information may help relieve stress for families and healthcare providers, and obviate routine laboratory evaluation for fever alone.
authors.affiliation: Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA.
authors.forename: Gideon W
authors.initials: GW
authors.lastname: Blumstein
authors.affiliation: Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA.
authors.forename: Lindsay M
authors.initials: LM
authors.lastname: Andras
authors.affiliation: Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA.
authors.forename: Derek A
authors.initials: DA
authors.lastname: Seehausen
authors.affiliation: Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Liam
authors.initials: L
authors.lastname: Harris
authors.affiliation: Department of Anesthesiology, Children's Hospital of Los Angeles, Los Angeles, CA.
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Ross
authors.affiliation: Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA. Electronic address: dskaggs@chla.usc.edu.
authors.forename: David L
authors.initials: DL
authors.lastname: Skaggs
mesh_terms: D000293:Adolescent; D002140:California / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000453:epidemiology / Q000209:etiology*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000150:complications / Q000453:epidemiology*; D013904:Thoracic Vertebrae; D013997:Time Factors; D055815:Young Adult