Early postoperative fever workup in children: utilization and utility

Corkum, Kristine S.; Hunter, Catherine J.; Grabowski, Julia; Lautz, Timothy B.

doi:10.1016/j.jpedsurg.2017.06.019

Cited by 16 publications

(24 citation statements)

References 22 publications

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“…A study examining postoperative fever in the elective pediatric surgical population queried 6943 patients, 30.6% of whom had developed postoperative fevers within the first 48 hours following surgery. 9 The authors found that early postoperative fever in the first 2 PODs is common in this population and is rarely associated with an infectious etiology.…”

Section: Discussionmentioning

confidence: 91%

Postoperative fever workup in pediatric neurosurgery patients

Raviv

Field

Adamo

2020

Journal of Neurosurgery: Pediatrics

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OBJECTIVEFevers are common in the postoperative period, and adult data indicate that workup for an isolated fever is not warranted in the first 4 postoperative days (PODs). Pediatric literature on the subject similarly questions the value of further investigation during the first 2 PODs. The purpose of this study was to determine the incidence of acute fever in the postoperative pediatric neurosurgical population, as well as to assess the utility of performing further workup on these patients.METHODSA single-institution retrospective study was performed to assess pediatric neurosurgery patients following surgical intervention for the diagnoses of craniosynostosis, Chiari malformation, and brain tumors from 2009 to 2018. Fevers were identified during the first 4 PODs and were defined as a temperature ≥ 38.0°C. The patient charts were queried for urinalysis and urine culture (UA/Ucx), chest radiographs, blood cultures, CSF culture, respiratory viral panel, white blood cell (WBC) count, transfusion history, development of wound infection, and placement of external ventricular drains (EVDs) or lumbar drains. Thirty-day postoperative microbiology results and readmissions were reviewed. Descriptive statistics were performed using logistic regression analysis.RESULTSTwo hundred thirty-five patients were evaluated, and 61% had developed fevers within the first 4 PODs. Thirty-eight (26.6%) of the 143 febrile patients underwent further workup, and those with high fevers (> 39.0°C) were more likely to undergo further evaluation, which most commonly included UA/Ucx (21.7%). Approximately 1% (2/235) of the patients were found to have an infection during the first 4 days, and 8 additional patients developed a complication following the initial 4 days and within the first 30 PODs. The development of infectious complications within the first 4 PODs did not correlate with acute postoperative fevers (p = 0.997), nor did the development of complications within the 30 days following surgery (p = 0.776); however, multiple days of acute postoperative fevers (p = 0.034) and the presence of an EVD (p = 0.001) were associated with the development of infectious complications within 30 days. Acute postoperative fevers were associated with EVD placement (p = 0.038), as well as blood product transfusions and an increased WBC count (p < 0.001).CONCLUSIONSIsolated fevers manifesting within the first 4 PODs are rarely associated with an infectious etiology. Additional factors should be taken into consideration when deciding to pursue further investigation.

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Section: Discussionmentioning

confidence: 91%

Postoperative fever workup in pediatric neurosurgery patients

Raviv

Field

Adamo

2020

Journal of Neurosurgery: Pediatrics

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“…Although postoperative fever in the first 48 hours has been historically attributed to atelectasis, there is growing evidence that the fever is due to a physiological response to tissue trauma caused by an increase in the complex cascade of inflammatory cytokines . Corkum et al . retrospectively reviewed 6943 adult patients undergoing elective surgery and found 30.6% developed fever.…”

Section: Discussionmentioning

confidence: 99%

Early postoperative fever in paediatric patients undergoing cochlear implant surgery

El‐Saied

Joshua

Tailakh

et al. 2017

Clinical Otolaryngology

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“…Early postoperative fever is common in pediatric surgical populations and is rarely associated with an infectious source. The incidence of a temperature >38°C in the first 48 hours postoperatively was low (5%) and much lower than the 30.6% identified in the study by Corkum et al 9 Altogether, monitoring of these adverse events demonstrates the ability of the App to help reporting side effects in pediatric outpatient surgeries on a continuous manner over a 10-day postoperative period.…”

Section: Discussionmentioning

confidence: 68%