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The following is a summary of “Postoperative fever and clinical outcomes after endoscopic surgery for spontaneous intracerebral hemorrhage: a retrospective database study,” published in the October 2024 issue of Neurology by Liu et al.    

Spontaneous intracerebral hemorrhage (SICH) poses significant risks of mortality and disability. Endoscopic surgery is increasingly utilized as a minimally invasive treatment for SICH.  

Researchers conducted a retrospective study evaluating the association between postoperative fever and clinical outcomes in patients with SICH undergoing endoscopic surgery.  

They involved patients aged 18 years or older with supratentorial SICH confirmed by computed tomography (CT) who underwent endoscopic hematoma evacuation within 48 hours of symptom onset. The main result was the modified Rankin Scale (mRS) score at 3 months. Secondary outcomes involved hospital and neurosurgical intensive care unit (NSICU) stays and perioperative complications. The link between postoperative fever (highest temperature within 24 hours after surgery) and these outcomes was analyzed using multivariate analysis, generalized additive models, and segmented regression analysis.  

The results showed at 3 months 56 patients, 38 had favorable outcomes (mRS ≤ 3), and 18 had unfavorable outcomes (mRS > 3). A threshold effect was observed at 38.2^° C between postoperative body temperature and clinical outcomes. Patients with postoperative fever (> 38.2^° C) had larger hematoma volumes (65 mL vs. 56 mL; P=0.008). Postoperative fever was linked with a 4.99-fold high risk of unfavorable outcomes (95% CI = [1.13 to 25.90]; P=0.040), which remained notable after excluding patients with postoperative complications (adjusted relative risk [RR] = 16.03; 95% CI = [1.69 to 417.24]; P=0.033). Postoperative fever was also linked with longer NSICU stays (3.1 days vs. 2.3 days; P=0.023) and longer hospital stays (17.2 days vs. 13.6 days; P=0.010).  

They concluded that a postoperative temperature threshold of 38.2^°C was linked to poorer outcomes in patients with SICH undergoing endoscopic surgery, underscoring the necessity for further research to mitigate postoperative fever and enhance recovery.  

Source: bmcneurol.biomedcentral.com/articles/10.1186/s12883-024-03898-4