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연구논문

Publication Journal 내용
· 영문제목 Postoperative fever after hemiarthroplasty in elderly patients over 70 years of age with displaced femoral neck fracture: Necessity of routine workup?
· 저자 Je-Hyun Yoo, Ki-Tae Kim, Tae-Young Kim, Ji-Hyo Hwang, Jun-Dong Chang
· 외부저자
· 발행정보 INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED
· 영문초록 Abstract
Objectives
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 xray and urinalysis would be necessary to rule out the two most common febrile complications such as pneumonia and urinary tract infection.