Postoperative fevers in pediatric solid tumor patients: how should they be managed?

Unlabelled: It is unclear how aggressively postoperative fevers should be managed in immunosuppressed pediatric oncology patients after major surgery. Little data exists on this subject. Therefore, a retrospective study of patients treated at our center was undertaken to examine this.

Purposes: (1) to describe the prevalence of fever and infection in postoperative pediatric solid tumor patients undergoing primary tumor resection, (2) to examine the risk factors that contribute to the development of postoperative infections, and (3) to describe the variation in practice in managing fevers.

Methods: Chart reviews were performed on patients diagnosed with a spectrum of tumor types from January 2000 to October 2005 who received preoperative chemotherapy, followed by tumor resection.

Results: Ninety-eight children met inclusion criteria and 73 (74%) developed fevers postoperatively; 14% of these had documented infections and 1 patient died from sepsis. Factors associated with increased risk of infection were a diagnosis of neuroblastoma (P=0.015), and surgery longer than 8 hours (P=0.059). The investigation and management of postoperative fevers varied in these patients.

Conclusions: Postoperative fevers may be indicative of severe infection. We suggest that a standardized approach to the management of these patients, including prompt physical assessment, clinical investigations, and empiric antibiotic consideration is vital to minimize complications.