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No Association Between Fever and Uninfected Hematoma in Postoperative Orthopedic Surgery and Traumatology

Author(s): Ilke Ilgaz, Joris Paccaud, Blaise Wyssa, Ilker Uckay

Objective: According to widespread belief or clinical experience, uninfected hematoma can cause fever. However, epidemiological data regarding this assumption are scant. We assess the epidemiology of hematoma and fever in the postoperative orthopedic context, in the context of surgical indications for revision surgery.

Methods: Single-center prospective observational study among adult orthopedic patients. All patients have anti-inflammatory medication and many have blood transfusions. Fever is defined as any axillary temperature ≥ 38°C (104°F), subfebrile temperatures as ≥ 37.2°C.

Results: Among 405 patients in the study, 164 had (40%) fever, 221 (55%) subfebrile temperatures, and 166 (41%) yielded visible hematomas. Overall, fever was not associated with hematoma (67/164 vs. 99/241; Pearson-χ², p=0.96). We equally found no association when analyzing only the subfebrile level (156/385 vs. 10/18; p=0.21) or when analyzing the temperatures only on Day 4 (p=0.95), Day 7 (p=1.00), or solely for cases requiring surgical re-intervention (4/10 vs. 6/9; Fisher-exact-test, p=0.37). As continuous variables, the maximum temperatures on each of the seven postoperative days were not higher for patients with hematoma (Wilcoxon-ranksum-tests; all p>0.10).

Conclusion: Within the time frame of one week postoperatively and real-life conditions, we failed to establish an epidemiological association between postoperative fever and the presence of hematoma in a large prospective observational study among adult orthopedic patients under anti-inflammatory drugs.

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