Increased postoperative febrile response in children with osteogenesis imperfecta
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Michelle Ghert1, Ben Allen, Jon Davids
1Shriners Hospital for Children, Greenville, South Carolina, USA. ghert001@yahoo.com
Insights
Children with osteogenesis imperfecta (OI) experience increased fever after surgery. This heightened febrile response (TFR) correlates with blood loss and surgery size, suggesting fever workups may be unnecessary without infection signs.
Area of Science:
- Pediatric Orthopedics
- Surgical Outcomes
- Genetics
Background:
- Osteogenesis imperfecta (OI) commonly necessitates surgical interventions for skeletal deformities.
- Postoperative fever is a frequent concern in pediatric surgical patients.
Purpose of the Study:
- To compare the postoperative febrile response in children with OI to a historical control group.
- To identify factors influencing febrile response in pediatric OI patients.
Main Methods:
- Retrospective review of 22 children with OI undergoing surgery.
- Comparison of total febrile response (TFR) with matched historical controls.
- Analysis of TFR correlation with surgical factors like blood loss and magnitude.
Main Results:
- Children with OI demonstrated a significantly higher TFR compared to controls across matched subgroups.
- Within the OI cohort, TFR positively correlated with estimated blood loss and surgical magnitude.
- Three fever workups in the OI group yielded no evidence of infection.
Conclusions:
- Children with OI exhibit an exaggerated febrile response postoperatively.
- Fever in OI patients post-surgery may not indicate infection and warrants careful evaluation.
- Avoid unnecessary fever workups and discharge delays in OI patients if infection signs are absent.
Abstract:
Children with osteogenesis imperfecta (OI) often require operative management to correct limb and spinal deformities. The authors reviewed the postoperative courses of 22 children with OI and compared the febrile responses of these children with those of matched subgroups within a published historical control ( 8). The subgroups were matched for perioperative conditions including the magnitude of surgery, estimated intraoperative blood loss, transfusion status, age, and gender. In all subgroups examined, the patients with OI exhibited a significant increase in total febrile response (TFR) compared with those in the historical control group. Within the OI group, TFR correlated with estimated blood loss and magnitude of surgery. There were three fever workups in the OI group with no evidence of infection found. In children with OI, fever workups and delays in hospital discharge should be avoided if physical signs of infection are absent.
