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Impact of dural opening on noninfectious postoperative fever in spinal surgery: a propensity-matched retrospective
Michita Noma1, Koji Nakajima1, Hideki Nakamoto1
1Department of Orthopedic Surgery, The University of Tokyo Hospital, Tokyo, Japan.
Purpose:
Dural opening in cranial surgery causes noninfectious prolonged fever, such as aseptic meningitis, often necessitating additional diagnostic testing and medical costs. However, its impact in spinal surgery remains underexplored.
Methods:
In this propensity-matched, retrospective multicentre study, data from 12,791 spinal surgeries performed between April 2017 and March 2024 at four institutions were reviewed. After excluding cases with pyrexia-inducing conditions and unintended dural injuries, 2,880 patients were identified. Propensity score matching yielded two balanced cohorts: a dural opening group (n = 166) and the control group without dural opening or injury (n = 166). Following post-enrolment exclusion of perioperative infections, 135 dural opening and 118 control cases were analysed. The primary outcome was prolonged postoperative fever (≥ 37.7 °C occurring on or after postoperative day 7). Subgroup analysis assessed risk factors for prolonged fever in the dural opening group.
Results:
Prolonged postoperative fever occurred significantly more in the dural opening group than in the control group (9% vs. 1%, p < 0.05). The dural opening group exhibited higher peak body temperatures, longer fever durations, elevated white blood cell counts, increased cerebrospinal fluid (CSF) leakage, longer operative times, greater blood loss, and extended postoperative hospitalisations (p < 0.05). Subgroup analysis revealed significant associations between postoperative fever and factors such as higher cranial-most surgical levels, CSF leakage, artificial dural reconstruction, and blood transfusion (p < 0.05).
Conclusion:
Dural opening during spinal surgery is associated with noninfectious postoperative fever. Identifying these associated key factors may help refine postoperative management strategies.
