title: Postoperative fever after hemiarthroplasty in elderly patients over 70 years of age with displaced femoral neck fracture: Necessity of routine workup?
abstract: OBJECTIVE
  Displaced femoral neck fracture in elderly patients has been treated with hemiarthroplasty as the treatment of choice. Fever following HA is common in these elderly patients. The aim of this study was to determine which post-HA fever workup could be beneficial in this group of patients.
  
  
  METHODS
  A total of 272 consecutive patients aged ≥70 years undergoing HA for displaced femoral neck fracture were retrospectively investigated. Postoperative fever (POF) was defined as any recorded body temperature ≥38°C in the early postoperative period. POF in each patient was characterized by the maximum temperature, the day of the first fever, and frequency of fever, stratified as either single or multiple fever spikes. Medical records were reviewed to identify positive fever workups and febrile complications.
  
  
  RESULTS
  Of 272 patients, 135 (49.6%) developed POF. A total of 428 routine diagnostic tests were performed in all patients with POF, of which only 57 tests (13.3%) were positive. Urinalysis showed the highest positive rate (21.9%), followed by urine culture (14.3%), chest x-ray (12.6%), and blood culture (1.1%). The most common febrile complication was pneumonia (12.6%), followed by urinary tract infection (8.1%). On multivariate logistic regression for positive workups, only fever after postoperative day (POD) 2 was a risk factor for positive chest x-ray (OR 3.86, p=0.016) and urine culture (OR 5.04, p=0.019). Moreover, fever after POD 2 (OR 6.93, p<0.0001) and multiple fever spikes (OR 2.92, p=0.026) were independent predictors of infectious febrile complications.
  
  
  CONCLUSIONS
  Routine workup for POF following hemiarthroplasty in elderly patients with displaced femoral neck fracture is not warranted. However, for fever after POD 2 and multiple fever spikes, chest x-ray and urinalysis would be necessary to rule out the two most common febrile complications such as pneumonia and urinary tract infection.
authors.affiliation: Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea. Electronic address: oships@hallym.ac.kr.
authors.forename: Je-Hyun
authors.initials: JH
authors.lastname: Yoo
authors.affiliation: Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea.
authors.forename: Ki-Tae
authors.initials: KT
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea.
authors.forename: Tae-Young
authors.initials: TY
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.
authors.forename: Ji-Hyo
authors.initials: JH
authors.lastname: Hwang
authors.affiliation: Department of Orthopaedic Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwasung, Republic of Korea.
authors.forename: Jun-Dong
authors.initials: JD
authors.lastname: Chang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005265:Femoral Neck Fractures / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D005334:Fever / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D062785:Hemiarthroplasty / Q000009:adverse effects*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D011184:Postoperative Period; D011237:Predictive Value of Tests; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D019564:Unnecessary Procedures
keywords: Diagnostic workup; Displaced femoral neck fracture; Hemiarthroplasty; Postoperative fever