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Perioperative fever and outcome in surgical patients with aneurysmal subarachnoid hemorrhage . OBJECTIVE We examined the incidence of perioperative fever and its relationship to outcome among patients enrolled in the Intraoperative Hypothermia for Aneurysm Surgery Trial . METHODS One thousand patients with initial World Federation of Neurological Surgeons grades of I to III undergoing clipping of intracranial aneurysms after subarachnoid hemorrhage were randomized to intraoperative normothermia ( 36 degrees C-37 degrees C ) or hypothermia ( 32.5 degrees C-33.5 degrees C ) . Fever ( > or =38.5 degrees C ) and other complications ( including infections ) occurring between admission and discharge ( or death ) were recorded . Functional and neuropsychologic outcomes were assessed 3 months postoperatively . The primary outcome variable for the trial was dichotomized Glasgow Outcome Scale ( good outcome versus all others ) . RESULTS Fever was reported in 41 % of patients . In 97 % of these , fever occurred in the postoperative period . The median time from surgery to first fever was 3 days . All measures of outcome were worse in patients who developed fever , even in those without infections or who were World Federation of Neurological Surgeons grade I. Logistic regression analyses were performed to adjust for differences in preoperative factors ( e.g. , age , Fisher grade , initial neurological status ) . This demonstrated that fever continued to be significantly associated with most outcome measures , even when infection was added to the model . An alternative stepwise model selection process including all fever-related measures from the preoperative and intraoperative period ( e.g. , hydrocephalus , duration of surgery , intraoperative blood loss ) resulted in the loss of significance for dichotomized Glasgow Outcome Scale , but significant associations between fever and several other outcome measures remained . After adding postoperative delayed ischemic neurological deficits to the model , only worsened National Institutes of Health Stroke Scale score , Barthel Activities of Daily Living index , and discharge destination ( home versus other ) remained independently associated with fever . CONCLUSION These findings suggest that fever is associated with worsened outcome in surgical subarachnoid hemorrhage patients , although , because the association between fever and the primary outcome measure for the trial is dependent on the covariates used in the analysis ( particularly operative events and delayed ischemic neurological deficits ) , we can not rule out the possibility that fever is a marker for other events . Only a formal trial of fever treatment or prevention can address this issue .
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Intervention_Control
intraoperative normothermia
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Outcome_Adverse-effects
Perioperative
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Outcome_Adverse-effects
Fever
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Outcome_Adverse-effects
other complications ( including infections ) occurring between admission and discharge
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Outcome_Mortality
death
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Outcome_Physical
Functional
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Outcome_Other
dichotomized Glasgow Outcome Scale ( good outcome versus all others ) .
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Outcome_Adverse-effects
Fever
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Outcome_Adverse-effects
fever
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Outcome_Physical
median time from surgery to first fever
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Outcome_Adverse-effects
infections
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Outcome_Adverse-effects
fever
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Outcome_Adverse-effects
infection
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Outcome_Adverse-effects
fever-related
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Outcome_Adverse-effects
fever
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Outcome_Physical
delayed ischemic neurological deficits
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Outcome_Physical
National Institutes of Health Stroke Scale score , Barthel Activities of Daily Living index , and discharge destination
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Outcome_Adverse-effects
fever
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Outcome_Adverse-effects
fever
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Outcome_Physical
delayed ischemic neurological deficits )
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Outcome_Adverse-effects
fever
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Outcome_Adverse-effects
fever