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  • Work up of Post-operative Fevers in Elective Craniotomies: A Pilot Study

    Final Number:
    1354

    Authors:
    Kristin Jaclyn Weaver MD; Kyle Michael Fargen MD MPH; Gregory J. Murad MD

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Traditionally, fever is considered the main sign of infection; however, it can be non-infectious in nature. Evaluating febrile patients usually results in reflexive ordering of many tests, most of which are negative. There is limited data on the incidence of post-operative fevers in neurosurgical patients. This study aimed to evaluate the incidence and timing of fevers and the diagnostic yields of the tests ordered.

    Methods: A retrospective chart review was performed on elective craniotomies from June 2011-June 2012. Patient demographics were collected. Aim 1: temperatures were recorded as a function of time to establish the “normal” temperature curve. Aim 2: the results of tests for fever workup were collected. Aim 3: patient charts were reviewed for return to OR for abscess, CSF leak, or wound revision. Fischer exact test was used for statistical analysis.

    Results: A total of 200 patients were evaluated. Summary statistics are seen in Table 1. In supratentorial surgery patients, diabetes is a risk factor for developing post-operative fevers. In the first 72 hr after craniotomy the chance of positive work up for a fever was low (5.6%). (Table 2) In infratentorial surgery patients, there were no associated risk factors for developing post-operative fevers. During the first 72 hr after craniotomy, the chance of positive work up for a fever was zero. (Table 3) For both groups, fever in the first 72 hours post-op does was not a predictor of future infection.

    Conclusions: The results showing very low positive rates for post-operative fever workup question whether there is a need for any work up in the first 72 hours. Further studies are needed to elucidate the questions “At what time post-op does a fever need to be worked up?” and “What is the ideal work up for post-operative fever?"

    Patient Care: The purpose of this pilot study was to: 1)to evaluate the incidence and timing of fevers in the elective neurosurgical post-operative population, 2) to evaluate the current practices in the Department of neurosurgery regarding post operative fevers, 3) to determine the diagnostic yields of the tests ordered, 4) to determine if post operative fevers are indicative of future complications and 5) ultimately, construct an evidence based algorithm for fever work up in post operative neurosurgical patients.

    Learning Objectives: The purpose of this pilot study was to: 1)to evaluate the incidence and timing of fevers in the elective neurosurgical post-operative population, 2) to evaluate the current practices in the Department of neurosurgery regarding post operative fevers, 3) to determine the diagnostic yields of the tests ordered, 4) to determine if post operative fevers are indicative of future complications and 5) ultimately, construct an evidence based algorithm for fever work up in post operative neurosurgical patients.

    References:

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