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Association of Postoperative Fever and Antibiotic Use with Surgical Site Infection in Children with Complicated

Johanna M Borst1, Alexandra Highet2, Willemijn LA Schäfer1

  • 1Department of Surgery, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.

Journal of the American College of Surgeons
|May 28, 2026
PubMed

Insights

Postoperative fever on day 3 or 4 strongly predicts surgical site infections in children with complicated appendicitis. Discharge antibiotics did not reduce post-discharge infections in afebrile children, suggesting fever-guided stewardship.

Area of Science:

  • Pediatric surgery
  • Infectious disease epidemiology
  • Antibiotic stewardship

Background:

  • Surgical site infection (SSI) risk after pediatric complicated appendicitis is hard to predict, leading to varied antibiotic prescribing.
  • Predicting SSI risk is crucial for appropriate antibiotic use and patient outcomes.

Purpose of the Study:

  • To determine if fever on postoperative day (POD) 3 or 4 can stratify SSI risk in children.
  • To evaluate if discharge antibiotics reduce post-discharge infections in afebrile children.

Main Methods:

  • Retrospective analysis of ACS NSQIP-P data (2019-2023) for children undergoing appendectomy for complicated appendicitis.
  • Examined associations between POD 3/4 fever, discharge antibiotics, and 30-day SSIs using multivariable models.

Main Results:

  • Fever on POD 3 or 4 was strongly associated with increased SSI risk (aOR 6.06).
  • Among afebrile children discharged on POD 3 or 4, discharge antibiotics showed no significant association with lower post-discharge SSI rates (aOR 1.03).

Conclusions:

  • POD 3 or 4 fever is a significant predictor of SSI in pediatric complicated appendicitis.
  • Discharge antibiotics do not appear to reduce post-discharge SSIs in afebrile children, supporting fever-guided antibiotic stewardship strategies.
Abstract

Keywords:
Antibiotic stewardshipComplicated appendicitisPediatric appendicitisPostoperative feverSurgical site infection

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