Clinical Investigation| Volume 364, ISSUE 6, P714-723, December 2022

Fever and hypothermia do not affect the all-cause 30-day hospital readmission



      One of the goals of the Affordable Care Act is to decrease hospital readmissions. While widely adhered to, there is no published research to support the practice of delaying discharge if patients exhibit fever or hypothermia in the preceding 24 h, which is the focus of our study.


      Retrospective analysis of the minimal (Tmin) and maximal (Tmax) body temperatures collected during the last 24 h before discharge of 19,038 inpatients. Fever was defined as Tmax >99.5F (+1SD from the mean Tmax) or >100.2F (+2SDs), and hypothermia as Tmin <97.1F (-1SD from the mean Tmin) or <96.7F (-2SDs).


      The overall readmission rate was 10.2% (highest for General Medicine and Pediatrics). The rate of readmission was not different between normothermic patients and those with abnormal body temperature, except for higher readmission rate (12.2%) for patients with fever at 1SD from Tmax compared with normothermic patients (9.96%). Neither fever nor hypothermia was associated with shorter time to readmission, except for fever at 2 SDs from Tmax (10.6 days) compared with normothermic patients (12.6 days). Surprisingly, univariate analysis revealed that higher Tmax and older age were associated with lower readmission probability. Both uni- and multivariate analysis showed that the presence of fever is associated with lower readmission probability. Evaluating 200 individual cases, the most common explanation for body temperature abnormality was infection and 90% of the preventable readmissions were due to infection.


      Abnormal body temperature 24 h prior to discharge was not useful for predicting the probability of readmission.

      Key Indexing Terms

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of the Medical Sciences
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kruse GB
        • Polsky D
        • Stuart EA
        • Werner RM.
        The impact of hospital pay-for-performance on hospital and Medicare costs.
        Health Serv Res. 2012; 47: 2118-2136
        • Mathes T
        • Pieper D
        • Morche J
        • Polus S
        • Jaschinski T
        • Eikermann M.
        Pay for performance for hospitals.
        Cochrane Database Syst Rev. 2019; 7CD011156
        • McIlvennan CK
        • Eapen ZJ
        • Allen LA.
        Hospital readmissions reduction program.
        Circulation. 2015; 131: 1796-1803
        • Khan A
        • Nakamura MM
        • Zaslavsky AM
        • et al.
        Same-hospital readmission rates as a measure of pediatric quality of care.
        JAMA Pediatr. 2015; 169: 905-912
        • CMS.GOV
        Hospital Readmissions Reduction Program (HRRP).
        2020 ([Accessed August 29, 2022])
        • Jencks SF
        • Williams MV
        • Coleman EA.
        Rehospitalizations among patients in the Medicare fee-for-service program.
        N Engl J Med. 2009; 360: 1418-1428
        • Bueno H
        • Ross JS
        • Wang Y
        • et al.
        Trends in length of stay and short-term outcomes among Medicare patients hospitalized for heart failure, 1993-2006.
        JAMA. 2010; 303: 2141-2147
        • Eastwood CA
        • Howlett JG
        • King-Shier KM
        • McAlister FA
        • Ezekowitz JA
        • Quan H.
        Determinants of early readmission after hospitalization for heart failure.
        Can J Cardiol. 2014; 30: 612-618
        • O'Connor M
        • Murtaugh CM
        • Shah S
        • et al.
        Patient characteristics predicting readmission among individuals hospitalized for heart failure.
        Med Care Res Rev. 2016; 73: 3-40
        • Osho AA
        • Castleberry AW
        • Yerokun BA
        • et al.
        Clinical predictors and outcome implications of early readmission in lung transplant recipients.
        J Heart Lung Transpl. 2017; 36: 546-553
        • Hyder O
        • Dodson RM
        • Nathan H
        • et al.
        Influence of patient, physician, and hospital factors on 30-day readmission following pancreatoduodenectomy in the United States.
        JAMA Surg. 2013; 148: 1095-1102
        • Eron LJ
        • Passos S.
        Early discharge of infected patients through appropriate antibiotic use.
        Arch Intern Med. 2001; 161: 61-65
        • Fanning J
        • Brewer J.
        Delay of hospital discharge secondary to postoperative fever–is it necessary?.
        J Am Osteopath Assoc. 2002; 102: 660-661
        • Walid MS
        • Sahiner G
        • Robinson C
        • Robinson 3rd, JS
        • Ajjan M
        • Robinson Jr, JS
        Postoperative fever discharge guidelines increase hospital charges associated with spine surgery.
        Neurosurgery. 2011; 68 (discussion 49): 945-949
        • Geneva II
        • Cuzzo B
        • Fazili T
        • Javaid W.
        Normal body temperature–A systematic review.
        Open Forum Infect Dis. 2019; 6: ofz032
        • Sund-Levander M
        • Forsberg C
        • Wahren LK.
        Normal oral, rectal, tympanic and axillary body temperature in adult men and women–A systematic literature review.
        Scand J Caring Sci. 2002; 16: 122-128
        • Chen W.
        Thermometry and interpretation of body temperature.
        Biomed Eng Lett. 2019; 9: 3-17
        • Protsiv M
        • Ley C
        • Lankester J
        • Hastie T
        • Parsonnet J.
        Decreasing human body temperature in the United States since the industrial revolution.
        Elife. 2020; 9: e49555
        • Geneva II
        • Cuzzo B
        • Fazili T
        • Javaid W.
        Comprehensive analysis of temperature in hospitalized patients.
        Am J Med Sci. 2019; 358: 134-142
        • Barone JE.
        Does fever at the time of discharge have any impact on the incidence of readmission?.
        Am Surg. 2008; 74: 1151-1153
        • Ni Choileain N
        • Redmond HP.
        Cell response to surgery.
        Arch Surg. 2006; 141: 1132-1140
        • Bytomski JR
        • Squire DL.
        Heat illness in children.
        Curr Sports Med Rep. 2003; 2: 320-324
        • Davis T.
        NICE guideline–Feverish illness in children–assessment and initial management in children younger than 5 years.
        Arch Dis Child Educ Pract Ed. 2013; 98: 232-235
        • Bailey MK
        • Weiss A.J.
        • Barrett M.L.
        • Jiang H.J.
        Characteristics of 30-Day All-Cause Hospital Readmissions, 2010-2016.
        Agency for Healthcare Research and Quality, 2019 (Available at:) (Accessed July 27, 2020)
        • Hollis RH
        • Graham LA
        • Richman JS
        • et al.
        Hospital readmissions after surgery: How important are hospital and specialty factors?.
        J Am Coll Surg. 2017; 224: 515-523