Routine Workup of Postoperative Pyrexia Following Total Joint Arthroplasty Is Only Necessary in Select Circumstances.
It is unclear when routine workup of postoperative pyrexia (POP) following total joint arthroplasty (TJA) should be performed.



A retrospective electronic database search was conducted on 25,558 consecutive patients undergoing primary or revision TJA between June 2001 and June 2013. We identified patient demographics, procedure type, characteristics of feverish patients, and febrile complications. The estimated costs for chest x-ray (CXR), urinalysis, urine culture, and blood culture were investigated.



POP occurred in 46% of TJAs. A total of 11,589 separate workups were performed in 90.5% of POP patients, of which 2.4% were positive. Urinalysis, urine culture, blood culture, and CXR were positive in 38.7%, 9.5%, 7.0%, and 0.2%, respectively. Febrile complications occurred in 4.5% and the infectious complications rate was 2.0%. The positive rate of fever workups was significantly higher in patients with the first POP occurring after postoperative day 3, POP > 102°F, multiple fever spikes, and patients undergoing revision TJA. Multivariate logistic regression revealed that the time of first POP, the maximum temperature, multiple fever spikes, and revision TJA were independent predictors of febrile complications. The estimated cost for 11,319 negative workups in patients with POP was $4,636,976.80, with CXR costing $4,613,182.00.



Selective workup of POP following TJA should be performed in patients with higher temperatures, fever occurring after postoperative day 3, those with multiple fever spikes, and those undergoing revision TJA. CXR with an extremely low positive rate should not routinely be ordered.
Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Anyang, South Korea.
Je-Hyun
JH
Yoo
The Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania.
Camilo
C
Restrepo
The Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania.
Antonia F
AF
Chen
The Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania.
Javad
J
Parvizi
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D000071997:Blood Culture / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D005334:Fever / Q000191:economics / Q000209:etiology*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D011184:Postoperative Period; D012086:Reoperation / Q000009:adverse effects; D012189:Retrospective Studies; D055815:Young Adult
cost; febrile complication; postoperative pyrexia; routine workup; total joint arthroplasty