The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Derek Ward - One of the best experts on this subject based on the ideXlab platform.
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cost and effectiveness of Postoperative Fever diagnostic evaluation in total joint arthroplasty patients
Journal of Arthroplasty, 2010Co-Authors: Derek Ward, Erik N Hansen, Steven K Takemoto, Kevin J BozicAbstract:The purpose of this study is to examine the characteristics and costs of Postoperative Fever diagnostic evaluations after total joint arthroplasty. All patients who underwent hip and knee arthroplasty (n = 1100) at a single institution for a 2-year period were included. Fever (temperature > or = 38.5 degrees C) occurred in 15% of patients. The rate of positive tests was as follows: chest radiograph (2%), blood culture (6%), urine culture (22%), and urinalysis (23.7%). Fever occurring after Postoperative day 3 (odds ratio [OR] 23.3; P < .001) and multiple days febrile (OR, 8.6; P = .003) are independent predictors of a positive workup, and patients with a maximum temperature of 39.0 degrees C or higher (25.4% vs 6.9%; P = .001) had a significantly higher rate of positive Fever evaluations. The total direct cost associated with Fever evaluations was $73 878, and cost per change in clinical management was $8209. Fever is a common occurrence after hip and knee arthroplasty, and many elements of an infectious evaluation are costly and clinically unnecessary.
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cost and effectiveness of Postoperative Fever workup in hip and knee arthroplasty patients
Journal of Arthroplasty, 2010Co-Authors: Erik N Hansen, Kevin J Bozic, Derek WardAbstract:s e25 James A. Rand Award Paper Cost and Effectiveness of Postoperative Fever Workup in Hip and Knee Arthroplasty Patients Erik N. Hansen, MD, Kevin J. Bozic, MD, MBA, Derek Ward, BA Introduction: There is evidence that Postoperative Fevers are a physiologic response to surgery, and extensive workups for an infection may be unnecessary and costly. The purpose of this study is to describe the incidence, characteristics, and costs of the Postoperative Fever workup after total hip and knee arthroplasty. Our hypothesis is that the standard Fever workup rarely changes clinical management and is thus inappropriate and cost ineffective. Methods: We examined the records of all 1100 patients who underwent hip and knee arthroplasty at a single academic institution over a 2 year period for documented Fever and infectious diagnostic workup. Multivariate regression analysis was used to identify patient variables and those related to the Fever that were predictive of a positive infectious workup. We determined the diagnostic yield of individual tests, resultant changes in clinical management, and the associated direct hospital costs. Results: Fever (T ≥ 38.5°C) occurred in 15% of all arthroplasty patients. A diagnostic workup was initiated for 43% of those with a recorded Fever, of which 35 tests were positive (14% of total) in 22 patients. The rate of positive workups was: chest x-ray (2%), blood culture (6%), urine culture (22%), and urinalysis (23.7%). Of the positive tests, 26% led to a change in management. Fever occurring N3 days postsurgery, and multiple days febrile were independently associated with a positive Fever workup (OR 7.3; P = .003 and OR 6; P = .001, respectively). Patients with a temperature ≥39.0°C had a significantly higher rate of positive Fever workup (24%) (P = .005). The direct costs spent in the evaluation of Fever over the study period were $73,878. Conclusion: While Fever is not uncommon after hip and knee arthroplasty, many elements of an infectious workup are clinically unnecessary and cost ineffective. We recommend pursing an infection workup only in those patients with a temperature ≥39.0°C, who are febrile for multiple days, or whose Fever occurs on Postoperative day 4 or later.
Kevin J Bozic - One of the best experts on this subject based on the ideXlab platform.
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cost and effectiveness of Postoperative Fever diagnostic evaluation in total joint arthroplasty patients
Journal of Arthroplasty, 2010Co-Authors: Derek Ward, Erik N Hansen, Steven K Takemoto, Kevin J BozicAbstract:The purpose of this study is to examine the characteristics and costs of Postoperative Fever diagnostic evaluations after total joint arthroplasty. All patients who underwent hip and knee arthroplasty (n = 1100) at a single institution for a 2-year period were included. Fever (temperature > or = 38.5 degrees C) occurred in 15% of patients. The rate of positive tests was as follows: chest radiograph (2%), blood culture (6%), urine culture (22%), and urinalysis (23.7%). Fever occurring after Postoperative day 3 (odds ratio [OR] 23.3; P < .001) and multiple days febrile (OR, 8.6; P = .003) are independent predictors of a positive workup, and patients with a maximum temperature of 39.0 degrees C or higher (25.4% vs 6.9%; P = .001) had a significantly higher rate of positive Fever evaluations. The total direct cost associated with Fever evaluations was $73 878, and cost per change in clinical management was $8209. Fever is a common occurrence after hip and knee arthroplasty, and many elements of an infectious evaluation are costly and clinically unnecessary.
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cost and effectiveness of Postoperative Fever workup in hip and knee arthroplasty patients
Journal of Arthroplasty, 2010Co-Authors: Erik N Hansen, Kevin J Bozic, Derek WardAbstract:s e25 James A. Rand Award Paper Cost and Effectiveness of Postoperative Fever Workup in Hip and Knee Arthroplasty Patients Erik N. Hansen, MD, Kevin J. Bozic, MD, MBA, Derek Ward, BA Introduction: There is evidence that Postoperative Fevers are a physiologic response to surgery, and extensive workups for an infection may be unnecessary and costly. The purpose of this study is to describe the incidence, characteristics, and costs of the Postoperative Fever workup after total hip and knee arthroplasty. Our hypothesis is that the standard Fever workup rarely changes clinical management and is thus inappropriate and cost ineffective. Methods: We examined the records of all 1100 patients who underwent hip and knee arthroplasty at a single academic institution over a 2 year period for documented Fever and infectious diagnostic workup. Multivariate regression analysis was used to identify patient variables and those related to the Fever that were predictive of a positive infectious workup. We determined the diagnostic yield of individual tests, resultant changes in clinical management, and the associated direct hospital costs. Results: Fever (T ≥ 38.5°C) occurred in 15% of all arthroplasty patients. A diagnostic workup was initiated for 43% of those with a recorded Fever, of which 35 tests were positive (14% of total) in 22 patients. The rate of positive workups was: chest x-ray (2%), blood culture (6%), urine culture (22%), and urinalysis (23.7%). Of the positive tests, 26% led to a change in management. Fever occurring N3 days postsurgery, and multiple days febrile were independently associated with a positive Fever workup (OR 7.3; P = .003 and OR 6; P = .001, respectively). Patients with a temperature ≥39.0°C had a significantly higher rate of positive Fever workup (24%) (P = .005). The direct costs spent in the evaluation of Fever over the study period were $73,878. Conclusion: While Fever is not uncommon after hip and knee arthroplasty, many elements of an infectious workup are clinically unnecessary and cost ineffective. We recommend pursing an infection workup only in those patients with a temperature ≥39.0°C, who are febrile for multiple days, or whose Fever occurs on Postoperative day 4 or later.
James F Wenz - One of the best experts on this subject based on the ideXlab platform.
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Postoperative Fever after total knee arthroplasty the role of cytokines
Clinical Orthopaedics and Related Research, 2003Co-Authors: Brett M Andres, Dennis D Taub, Ilksen Gurkan, James F WenzAbstract:Febrile temperatures commonly are seen after total knee arthroplasty, but their source and importance are unclear. The goal of the current study was to determine whether such Fevers are part of the normal physiologic response to surgery mediated by inflammatory cytokines. In 20 patients who had total knee arthroplasty, serum and wound drain fluid samples were collected preoperatively and at 1, 6, 24, and 48 hours Postoperatively; oral temperatures were measured Postoperatively every 4 hours for 3 days. Concentrations of interleukin 1beta, interleukin 6, and tumor necrosis factor alpha in the samples were measured via enzyme-linked immunosorbent assays and compared in patients who did and did not have Fevers develop (>or=38.5 degrees C). Gender, age, operative time, amount of blood loss or drain output, anesthesia type, drop in hematocrit, and transfusion administration were not associated with Fever. Significant increases were seen Postoperatively in drain fluid concentrations of interleukin 1beta and interleukin 6 and in serum concentrations of interleukin 6. Patients who were febrile had significantly higher drain and serum interleukin 6 concentrations than patients who were afebrile. These findings suggest that Fevers seen after total knee arthroplasty are at least partly the result of surgical site inflammation and subsequent local and systemic release of the endogenous pyrogen interleukin 6.
Erik N Hansen - One of the best experts on this subject based on the ideXlab platform.
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cost and effectiveness of Postoperative Fever diagnostic evaluation in total joint arthroplasty patients
Journal of Arthroplasty, 2010Co-Authors: Derek Ward, Erik N Hansen, Steven K Takemoto, Kevin J BozicAbstract:The purpose of this study is to examine the characteristics and costs of Postoperative Fever diagnostic evaluations after total joint arthroplasty. All patients who underwent hip and knee arthroplasty (n = 1100) at a single institution for a 2-year period were included. Fever (temperature > or = 38.5 degrees C) occurred in 15% of patients. The rate of positive tests was as follows: chest radiograph (2%), blood culture (6%), urine culture (22%), and urinalysis (23.7%). Fever occurring after Postoperative day 3 (odds ratio [OR] 23.3; P < .001) and multiple days febrile (OR, 8.6; P = .003) are independent predictors of a positive workup, and patients with a maximum temperature of 39.0 degrees C or higher (25.4% vs 6.9%; P = .001) had a significantly higher rate of positive Fever evaluations. The total direct cost associated with Fever evaluations was $73 878, and cost per change in clinical management was $8209. Fever is a common occurrence after hip and knee arthroplasty, and many elements of an infectious evaluation are costly and clinically unnecessary.
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cost and effectiveness of Postoperative Fever workup in hip and knee arthroplasty patients
Journal of Arthroplasty, 2010Co-Authors: Erik N Hansen, Kevin J Bozic, Derek WardAbstract:s e25 James A. Rand Award Paper Cost and Effectiveness of Postoperative Fever Workup in Hip and Knee Arthroplasty Patients Erik N. Hansen, MD, Kevin J. Bozic, MD, MBA, Derek Ward, BA Introduction: There is evidence that Postoperative Fevers are a physiologic response to surgery, and extensive workups for an infection may be unnecessary and costly. The purpose of this study is to describe the incidence, characteristics, and costs of the Postoperative Fever workup after total hip and knee arthroplasty. Our hypothesis is that the standard Fever workup rarely changes clinical management and is thus inappropriate and cost ineffective. Methods: We examined the records of all 1100 patients who underwent hip and knee arthroplasty at a single academic institution over a 2 year period for documented Fever and infectious diagnostic workup. Multivariate regression analysis was used to identify patient variables and those related to the Fever that were predictive of a positive infectious workup. We determined the diagnostic yield of individual tests, resultant changes in clinical management, and the associated direct hospital costs. Results: Fever (T ≥ 38.5°C) occurred in 15% of all arthroplasty patients. A diagnostic workup was initiated for 43% of those with a recorded Fever, of which 35 tests were positive (14% of total) in 22 patients. The rate of positive workups was: chest x-ray (2%), blood culture (6%), urine culture (22%), and urinalysis (23.7%). Of the positive tests, 26% led to a change in management. Fever occurring N3 days postsurgery, and multiple days febrile were independently associated with a positive Fever workup (OR 7.3; P = .003 and OR 6; P = .001, respectively). Patients with a temperature ≥39.0°C had a significantly higher rate of positive Fever workup (24%) (P = .005). The direct costs spent in the evaluation of Fever over the study period were $73,878. Conclusion: While Fever is not uncommon after hip and knee arthroplasty, many elements of an infectious workup are clinically unnecessary and cost ineffective. We recommend pursing an infection workup only in those patients with a temperature ≥39.0°C, who are febrile for multiple days, or whose Fever occurs on Postoperative day 4 or later.
Sarang Kasture - One of the best experts on this subject based on the ideXlab platform.
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is immediate Postoperative Fever related to drop in haemoglobin a comparative study in simultaneous bilateral total knee arthroplasty patients
European Journal of Orthopaedic Surgery and Traumatology, 2013Co-Authors: Vijay Shetty, Sarang KastureAbstract:The purpose of the study was to assess whether Fever in the immediate Postoperative period after total knee arthroplasty was indeed related to the fall in haemoglobin. Only patients undergoing bilateral simultaneous total knee replacement were included in the study since the fall in haemoglobin is expected to be more as compared to unilateral cases. The mean fall in haemoglobin of 25 patients having immediate Postoperative Fever (‘Fever group’) was compared with 27 patients having no Fever (‘no-Fever group’). Though the mean fall of haemoglobin in ‘Fever group’ was more compared to ‘no-Fever group’, the difference was not statistically significant. Therefore, this study does not support the view that immediate Postoperative Fever after total knee arthroplasty is related to drop in haemoglobin.