Fever Following Open Surgical Repair of Craniosynostosis

Postoperative fever is a known phenomenon in the acute phase following open surgical repair of craniosynostosis. However, its risk factors, etiology, and the utility of performing a workup are not well understood. The aim of this study is to evaluate the incidence, risk factors, and complications associated with fever following open surgical repair of craniosynostosis.

A single-institution retrospective study was performed to assess all patients who underwent open surgical correction of craniosynostosis at Hershey Medical Center between January 2017 and December 2022. Postoperative fever was defined as a temperature above 38 °C during the first 4 days after surgery. Patient demographics and characteristics pertaining to craniosynostosis were collected, and fever curves were analyzed.

Of the 75 patients included, 23 (30%) developed postoperative fever. One child underwent an infectious work-up with no identifiable source. All children had fever resolution without antibiotics within an average of 14.75 hours from onset. There was no association with intraoperative durotomy (P=0.52), estimated blood loss (P=0.42), intraoperative blood administration (P=0.68), weight (P=0.39), or age (P=0.19). Fever development was not associated with postoperative complications, return to operating room, 30-day readmission (P=0.38), or hospital length of stay (P=0.20).

Approximately 1 in 3 children developed postoperative fever following open surgical repair of craniosynostosis. These fevers resolved spontaneously and were not associated with intraoperative durotomy or with postoperative outcomes. These results support close clinical observation in otherwise well-appearing patients with prompt evaluation and treatment when clinically warranted.