Postoperative Fever Following Pelvic and Acetabular Fixation: Incidence, Risk Factors, and Lack of Association With Surgical Site Infection.

Abstract

Background: Despite numerous studies showing postoperative fever can be a common and benign occurrence, there is still a significant and costly workup when fevers occur after surgery, including for orthopedic patients with pelvic ring and acetabular injuries.

Material and methods: A total of 204 patients undergoing pelvis and/or acetabular fixation were analyzed for fever, with positive fever defined as temperature >38° Celsius. Age, sex, substance use, smoking history, body mass index, diabetes, comorbidities, American Society of Anesthesiologists (ASA) score, fracture morphology, polytrauma, surgical treatment, transfusion requirements, operative time, estimated blood loss, use of vancomycin powder, and surgical site infection (SSI) were all recorded. Surgical site infection was defined as an infection at the surgical site requiring reoperation, with positive cultures at time of secondary surgery.

Results: SSI was not associated with postoperative fever in patients undergoing pelvic and/or acetabular fixation. Higher ASA score, polytrauma, combined pelvic ring-acetabular fractures, open pelvic ring injuries, increased intraoperative blood loss, increased surgical time, and transfusions were associated with higher rates of fevers on univariate analysis. Multivariate analysis showed transfusions were the only independent risk factor for developing fever.

Conclusion: Surgeons and clinicians managing orthopedic patients should be aware that postoperative fever is common after pelvis and acetabular fixation and is rarely related to SSI. [Orthopedics. 2025;48(4):229-233.].