Association Between Postoperative Fever and Readmission Rates Following Cervical Fusion

Introduction: This study assessed postoperative fever rates in cervical fusion patients and its impact on readmission, length of stay, healthcare utilization, and revision surgery rates.

Methods: The electronic medical record at an urban academic medical center was retrospectively reviewed for patients who underwent elective cervical fusion procedures utilizing either a combined approach or posterior only approach from 2016 to 2021. Revision procedures for adjacent-level or recurrent same level disease were also included, all other revision cases were excluded. Patient demographics, surgical characteristics, length of stay (LOS), and readmission rates were collected. Patients were categorized into "No-Fever" (no documented fever) and "Fever" (documented postoperative fever) groups, with postoperative fever defined as a temperature > 100.4°F. Additional temperature-related data and medical tests ordered in response to fever were documented. Patients with identified fevers were 2:1 propensity-matched to those without.

Results: Among 884 patients, 6.1% developed postoperative fever during their hospitalization. Patients with postoperative fever had an average LOS that was significantly longer than the no-fever group (5.14 vs. 3.17 days, p=0.001). Fever workup included various tests, with infection identified as the underlying cause for the fever in only 1.9%. Furthermore, chest radiographs were more common in the "Fever" group (0.33 vs. 0.05, p=0.006). Blood cultures, urine cultures, vascular ultrasounds, and white blood cell counts were similar. No significant differences in readmission incidence (p=0.316) or time to readmission (11.8 vs. 24.8 days, p=0.395) were found.

Conclusion : Postoperative fever following cervical spine surgery is relatively common but rarely indicates infection. It leads to extensive diagnostic workups and longer hospital stays without increasing readmission rates. This study underscores the need for a more focused and cost-effective approach to evaluating postoperative fever, suggesting that early discharge may reduce healthcare costs without compromising patient safety.