Early postoperative fever workup in children: utilization and utility

Area of Science:

• Pediatric Surgery
• Infectious Disease
• Clinical Outcomes

Background:

• Early postoperative fever is a frequent occurrence in pediatric surgical patients.
• Limited data exists on the diagnostic workup and yield of fever investigations in children compared to adults.
• Understanding fever patterns and test utility is crucial for appropriate clinical management.

Purpose of the Study:

• To determine the incidence of early postoperative fever in pediatric surgical patients.
• To evaluate the utilization and diagnostic yield of common laboratory and imaging tests ordered for fever.
• To inform evidence-based guidelines for fever workup in this population.

Main Methods:

• Retrospective analysis of 6943 pediatric surgical patients undergoing elective inpatient/observational surgery (2011-2015).
• Early fever defined as temperature >38.0°C within two days post-procedure.
• Data collected on blood cultures, urinalysis, urine cultures, chest radiographs, and respiratory viral panels.

Main Results:

• 30.6% of patients developed early postoperative fever.
• Positive findings were low: blood cultures (0.69%), chest radiographs (3.0% infectious).
• Urinalysis and urine cultures showed higher positivity but were often associated with urinary catheter use.

Conclusions:

• Early postoperative fever is common in pediatric surgical patients and seldom linked to an infection.
• Selective application of diagnostic workup for fever is recommended.
• Current testing strategies may be overutilized without significant diagnostic benefit.