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.

Method

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 ≥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.

Conclusion

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.