Normal postoperative febrile response in the pediatric orthopaedic population

Postoperative fever in the pediatric orthopaedic population remains a clinical concern even though prior studies concluded that fevers are a poor predictor of surgical complications. In this retrospective study of 177 patients, we established guidelines regarding the degree and time course of fever we should expect based on the perioperative conditions of magnitude of surgery, duration of surgery, need for intraoperative transfusion, estimated blood loss, age, and gender. To provide a more sensitive assessment of fever, we developed composite temperature curves for each patient and defined the area under these curves as the total febrile response (TFR). This allowed us to assess fever as a cumulative event, taking into account both its magnitude and duration. A multivariate model then determined that of the perioperative conditions studied, intraoperative transfusion status and estimated blood loss were most helpful in predicting a patient's TFR. The results of this study can be used as an additional tool for assessing postoperative progress and whether a fever is within the normal limits indicated by a patient's perioperative variables.