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The significance of post-operative fever following airway reconstruction
Scott A Schraff1, Cheryl Brumbaugh, Jareen Meinzen-Derr
1Arizona Otolaryngology Consultants, PC, ENT, 333 E Virginia Ave, Suite 101, Phoenix, AZ 85004, United States. Schraffs@Hotmail.com
Insights
Most children undergoing laryngotracheoplasty (LTP) have insignificant fevers. Single-stage LTP and post-operative atelectasis increase fever risk in pediatric airway reconstruction patients.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Surgery
- Critical Care Medicine
Background:
- Post-operative fever is common in children after airway reconstruction.
- Defining the significance of these fevers is crucial for appropriate management.
Purpose of the Study:
- To retrospectively review pediatric airway reconstruction cases to define the significance of post-operative fever.
- Identify risk factors associated with significant post-operative fevers.
Main Methods:
- Retrospective analysis of 78 pediatric laryngotracheoplasties (LTPs).
- Fever defined as temperature ≥38.5°C.
- Significant fever defined by positive cultures or elevated WBC; Chest X-ray (CXR) and comorbidities analyzed.
Main Results:
- 45% of patients developed fever; 20.5% had significant fevers.
- Single-stage LTP (SSLTP) patients had higher fever risk (59%) vs. double-stage LTP (DSLTP) (15%).
- Post-operative atelectasis was strongly associated with fever (93%), but not necessarily significant fever.
Conclusions:
- Most post-operative fevers in pediatric airway reconstruction are insignificant.
- SSLTP and post-operative atelectasis are risk factors for fever.
- Consider thorough fever work-up for DSLTP or cases with non-atelectasis CXR findings.
Objective:
Post-operative management of children undergoing airway reconstruction has been well-described. However, many of these patients develop post-operative fevers. We conducted a retrospective review in an attempt to define the significance of post-operative fever following pediatric airway reconstruction.
Method:
Retrospective analysis of 78 pediatric laryngotracheoplasties (LTPs) from May 1, 2006 - April 30, 2007 at a tertiary care pediatric hospital. Fever was defined as temperature >or=38.5. A fever was "significant" if accompanied by a positive sputum, blood or urine culture, or an elevated WBC. Chest radiograph (CXR) results and co-morbidities were examined.
Results:
Forty-five percent of cases (35/78) had fever. Of those febrile, 46% (n=16) had significant fever. Overall, 20.5% had significant fevers. Fifty-two cases were single-stage LTP (SSLTP) with 31 febrile and 26 cases were double-stage LTP (DSLTP) with 4 febrile. SSLTP cases were at a significantly greater risk for post-operative fever compared with DSLTP, 59% vs 15% respectively (p=0.0002). 42% of febrile SSLTPs (n=13) had significant fevers compared to 50% (n=2) of febrile DSLTPs (Fisher's Exact p=1.0). 81.5% of cases with CXR findings had fevers, but only 50% of these fevers were significant. Subjects with post-operative atelectasis were more likely to have a fever compared to subjects with no post-operative atelactasis (93% vs. 33% respectively, p<0001). 30.8% of those with atelectasis had significant fever, compared to 52% of those without atelectasis (p=0.2) and 25 of SSLTPs vs. 3.9% of DSLTPs had atelactasis (p=0.027). No comorbidities were shown to be significant risk factors for post-operative fever.
Conclusion:
Based on our review, most children undergoing LTPs will have insignificant fevers. Those children undergoing SSTLP and/or having post-operative atelectasis are at higher risk for post-operative fever. Fevers in children with double-stage procedures or all reconstruction cases with CXR findings other than atelectasis should have a thorough fever work-up.
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