The significance of post-operative fever following airway reconstruction.
OBJECTIVE
Post-operative management of children undergoing airway reconstruction has been well-described. However, many of these patients develop post-operative fevers. We conducted a retrospective review in an attempt to define the significance of post-operative fever following pediatric airway reconstruction.


METHODS
Retrospective analysis of 78 pediatric laryngotracheoplasties (LTPs) from May 1, 2006 - April 30, 2007 at a tertiary care pediatric hospital. Fever was defined as temperature >or=38.5. A fever was "significant" if accompanied by a positive sputum, blood or urine culture, or an elevated WBC. Chest radiograph (CXR) results and co-morbidities were examined.


RESULTS
Forty-five percent of cases (35/78) had fever. Of those febrile, 46% (n=16) had significant fever. Overall, 20.5% had significant fevers. Fifty-two cases were single-stage LTP (SSLTP) with 31 febrile and 26 cases were double-stage LTP (DSLTP) with 4 febrile. SSLTP cases were at a significantly greater risk for post-operative fever compared with DSLTP, 59% vs 15% respectively (p=0.0002). 42% of febrile SSLTPs (n=13) had significant fevers compared to 50% (n=2) of febrile DSLTPs (Fisher's Exact p=1.0). 81.5% of cases with CXR findings had fevers, but only 50% of these fevers were significant. Subjects with post-operative atelectasis were more likely to have a fever compared to subjects with no post-operative atelactasis (93% vs. 33% respectively, p<0001). 30.8% of those with atelectasis had significant fever, compared to 52% of those without atelectasis (p=0.2) and 25 of SSLTPs vs. 3.9% of DSLTPs had atelactasis (p=0.027). No comorbidities were shown to be significant risk factors for post-operative fever.


CONCLUSIONS
Based on our review, most children undergoing LTPs will have insignificant fevers. Those children undergoing SSTLP and/or having post-operative atelectasis are at higher risk for post-operative fever. Fevers in children with double-stage procedures or all reconstruction cases with CXR findings other than atelectasis should have a thorough fever work-up.
Schraff
Scott A
SA
Arizona Otolaryngology Consultants, PC, ENT, 333 E Virginia Ave, Suite 101, Phoenix, AZ 85004, United States. Schraffs@Hotmail.com
Brumbaugh
Cheryl
C
Meinzen-Derr
Jareen
J
Willging
J Paul
JP
D016470:Bacteremia / Q000453:epidemiology; D002675:Child, Preschool; D005334:Fever / Q000453:epidemiology*; D006801:Humans; D007829:Laryngostenosis / Q000601:surgery; D007830:Larynx / Q000601:surgery*; D007958:Leukocyte Count; D009820:Ohio / Q000453:epidemiology; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods; D010996:Pleural Effusion / Q000453:epidemiology; D011014:Pneumonia / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D001261:Pulmonary Atelectasis / Q000453:epidemiology; D012189:Retrospective Studies; D013183:Sputum / Q000382:microbiology; D014132:Trachea / Q000601:surgery*; D014135:Tracheal Stenosis / Q000601:surgery; D014556:Urine / Q000382:microbiology