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Fever and Systemic Inflammatory Response Syndrome After Wide Resection of Pediatric Bone Sarcomas
Kathryn E Gallaway1, Louise A Atadja, Alexandra K Callan
1Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, TX.
Insights
Postoperative fever and SIRS are common in pediatric bone sarcoma patients but do not reliably predict complications. Avoid extensive infectious workups for fever or SIRS alone in these patients.
Area of Science:
- Pediatric Oncology
- Surgical Complications
- Infectious Disease
Background:
- Postoperative fever is common but poorly understood in pediatric bone sarcoma patients.
- Limited data exists on the predictive value of fever and SIRS for complications in this group.
- Early identification of complications is crucial to avoid delaying adjuvant therapy.
Purpose of the Study:
- To determine the prevalence of postoperative fever and SIRS in pediatric patients after bone sarcoma resection.
- To assess the association between fever, SIRS, and wound or infectious complications.
- To evaluate the predictive value of fever and SIRS for complications.
Main Methods:
- Retrospective chart review of pediatric patients undergoing wide resection for bone sarcomas (January 2018 - December 2020).
- Analysis of fever (>38°C) and Systemic Inflammatory Response Syndrome (SIRS) criteria.
- Calculation of positive predictive values (PPVs) for complications.
- Level II-prognostic retrospective study.
Main Results:
- 22 patients with osteosarcoma or Ewing sarcoma were identified.
- 68.2% developed fever and 90.9% met SIRS criteria postoperatively.
- The rate of wound/infectious complications was 27.3%.
- Fever and SIRS had low PPVs (26.7% and 31.0%) for complications.
- No significant association found between fever/SIRS and complications, though high fever (>39°C) showed a trend (OR: 6.00).
Conclusions:
- Pediatric bone sarcoma patients frequently exhibit fever and SIRS post-surgery.
- Fever and SIRS are poor predictors of infectious or wound complications.
- Extensive infectious workups are not recommended for fever or SIRS alone; clinical signs are key.
Background:
While postoperative fever is common and thought to be physiological, data is limited in pediatric patients with bone sarcomas. Understanding the predictive value of postoperative fever and systemic inflammatory response syndrome (SIRS) in this population is essential to guide further workup and avoid delays in adjuvant therapy. The aim of this study is to characterize the prevalence of postoperative fever and SIRS in pediatric patients undergoing wide resection of bone sarcomas and to determine whether these signs are associated with wound or infectious complications.
Methods:
A retrospective chart review of cases performed by a single surgeon between January 2018 and December 2020 was performed.
Results:
Twenty-two patients were identified. All patients had pathology-confirmed diagnoses of osteosarcoma (77.3%) or Ewing sarcoma (22.7%). Before discharge, 68.2% developed a fever >38°C and 90.9% met SIRS criteria. The rate of wound and infectious complications during the first 6 weeks after surgery was 27.3%. The positive predictive values (PPV) of fever and SIRS were low at 26.7% and 31.0% respectively. No association between complications and fever [dds ratio (OR): 0.91, 95% confidence interval (CI): 0.12-6.72] or SIRS (OR: 2.24, 95% CI: 0.78-46.14) was identified. High fever >39°C had a better PPV of 50.0%. However, the association between high fever and complications did not reach significance (OR: 6.00, 95% CI: 0.78-46.14). Age, tumor size, days from chemo to surgery, duration of surgery, estimated blood loss, number of packed red blood cells units transfused, and length of stay were not associated with the development of postoperative fever or complications.
Conclusion:
Pediatric patients undergoing wide resection of bone sarcomas frequently mount a robust SIRS response after surgery. However, fever and SIRS are both poor predictors of infection and wound complications. Patients with postoperative fever or SIRS should not undergo an extensive infectious workup unless there are clear signs or symptoms to suggest an infectious etiology.
Level Of Evidence:
Level II-prognostic retrospective study.
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