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Postoperative fevers in pediatric solid tumor patients: how should they be managed?
Eleanor Hendershot1, Ann Chang, Kimberly Colapinto
1Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada. eleanor.hendershot@sickkids.ca
Insights
Postoperative fevers in pediatric oncology patients may signal severe infection. A standardized approach including prompt assessment and antibiotics is vital to minimize complications in these high-risk patients.
Area of Science:
- Pediatric Oncology
- Surgical Infections
- Immunocompromised Patients
Background:
- Management of postoperative fevers in pediatric oncology patients after major surgery is not well-defined.
- Limited data exists on fever and infection prevalence and risk factors in this population.
Purpose of the Study:
- To determine the prevalence of fever and infection in pediatric solid tumor patients post-resection.
- To identify risk factors for postoperative infections.
- To describe current practices in fever management.
Main Methods:
- Retrospective chart review of pediatric patients with solid tumors undergoing primary tumor resection.
- Inclusion criteria: preoperative chemotherapy followed by tumor resection.
- Data collected from January 2000 to October 2005.
Main Results:
- 74% of 98 patients developed postoperative fevers; 14% had documented infections.
- Neuroblastoma diagnosis and surgeries exceeding 8 hours were associated with increased infection risk.
- Significant variation in fever investigation and management practices observed.
Conclusions:
- Postoperative fevers in this cohort can indicate severe infection.
- A standardized management approach is crucial.
- Recommendations include prompt assessment, clinical investigation, and consideration of empiric antibiotics.
Unlabelled:
It is unclear how aggressively postoperative fevers should be managed in immunosuppressed pediatric oncology patients after major surgery. Little data exists on this subject. Therefore, a retrospective study of patients treated at our center was undertaken to examine this.
Purposes:
(1) to describe the prevalence of fever and infection in postoperative pediatric solid tumor patients undergoing primary tumor resection, (2) to examine the risk factors that contribute to the development of postoperative infections, and (3) to describe the variation in practice in managing fevers.
Methods:
Chart reviews were performed on patients diagnosed with a spectrum of tumor types from January 2000 to October 2005 who received preoperative chemotherapy, followed by tumor resection.
Results:
Ninety-eight children met inclusion criteria and 73 (74%) developed fevers postoperatively; 14% of these had documented infections and 1 patient died from sepsis. Factors associated with increased risk of infection were a diagnosis of neuroblastoma (P=0.015), and surgery longer than 8 hours (P=0.059). The investigation and management of postoperative fevers varied in these patients.
Conclusions:
Postoperative fevers may be indicative of severe infection. We suggest that a standardized approach to the management of these patients, including prompt physical assessment, clinical investigations, and empiric antibiotic consideration is vital to minimize complications.
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