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FEVER WITHOUT INFECTION: DE-ESCALATING DIAGNOSTIC WORKUPS IN PEDIATRIC CRANIOSYNOSTOSIS PATIENTS
Michael Hernandez
*, Ethan Richlak, Viraj Govani
1, Tiffany Jeong, Alzbeta Novotna, Shelby Nathan, Jesse A. Goldstein
Plastic Surgery, University of Pittsburgh, Pittsburgh, PA
BACKGROUNDFever is a frequent postoperative event following open craniosynostosis repair, yet remains poorly characterized in pediatric patients. While adult cranioplasty series report infection rates of 8-11%, comparable pediatric data are not well defined. Better delineation of fever incidence, timing, and infection risk is critical to optimize care and reduce unnecessary diagnostics.
METHODSWe conducted a retrospective review of all pediatric patients (0-20 years) undergoing cranial vault remodeling, fronto-orbital advancement, or strip craniectomy at a single tertiary children's hospital from 2003-2024. Fever was defined as ≥38.0°C. Outcomes included fever incidence, peak timing, culture use, and SSI. Subgroup analyses compared febrile patients who underwent culture workups versus those who did not.
RESULTSAmong 313 patients, 119 (38.0%) developed postoperative fever. Most were early and self-limited, with median onset POD1. Cultures were obtained in 36/119 (30.3%), yielding two positives (5.6%). Both infections occurred in patients undergoing their first cranial surgery, and each was clinically distinct. One demonstrated a POD2 fever spike to 40.3°C and a prolonged LOS of 8 days, while the other had persistent low-grade fevers with LOS of 5 days. These contrasted with the majority of febrile patients who had short-lived fevers and routine LOS. Compared with non-workup patients (n=83), those who underwent workup (n=36) had longer LOS (156 vs 84 hours) and slightly higher POD1-2 fevers (38.6°C vs 38.2°C). Despite being more clinically concerning, the infection rate remained extremely low (0.6% overall).
CONCLUSIONSPostoperative fever is common but rarely indicates infection. With a 60:1 fever-to-infection ratio and lower rates than adult cranioplasty, most fevers likely represent benign physiologic responses. These findings support de-escalation of fever-based evaluation protocols in this population.
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