Early postoperative fever in pediatric oncology patients undergoing solid tumor resection

Infographic · Nov 2025 · 1 min read

In brief

This retrospective study of 222 pediatric oncology patients found that 42% developed early postoperative fever after solid tumor resection, but only 2.8% had true infections requiring treatment. Risk factors included transfusion, neutropenia, and sarcoma histology, suggesting routine fever workups may be unnecessary in hemodynamically stable patients within the first 2 postoperative days.

42% of pediatric oncology patients develop fever in first 2 postoperative days after solid tumor resection, but only 2.8% have true infection
Transfusion, foley catheter, neutropenia, and sarcoma histology are significant predictors of early postoperative fever
Routine fever workup costs average $455 per patient with minimal diagnostic yield when hemodynamic stability is maintained
Empiric antibiotics were given to 36% of febrile patients despite infectious etiology being rare in early postoperative period
Reserve testing and treatment for patients with hemodynamic instability or significant symptoms beyond isolated fever alone

Written by the GCMD Library team from the infographic.

The infographic uses a teal, green, and yellow color scheme with cartoon illustrations of medical staff and pediatric patients. The layout flows top to bottom with key statistics highlighted in large text, supported by icons of bacteria/viruses and medical equipment. A conclusion banner appears at the bottom in yellow.

John Lundstedt, Emily Vore, Joseph Brungardt, Meera Kotagal, Todd Jenkins, Chloe Boehmer, Roshni Dasgupta

Abstract

Background: Postoperative fever is common following cancer resection and often prompts extensive, costly workups. The purpose of this study was to determine the incidence of and risk factors for postoperative fever in oncology patients, evaluate incidence of true infection, and determine the utility of fever workup.

Methods: Single institution retrospective chart review (2018-2023) identified postoperative oncology patients who developed postoperative fever (≥38.0 °C) on postoperative days 0, 1, or 2 following solid tumor resection. Collected variables included preoperative chemotherapy, presence of central line, operation type, bowel resection, operative length, wound class, intraoperative hypothermia (<35 °C), transfusion, hyperglycemia (>180 mg/dL), preoperative neutrophil count, and antibiotic administration. Fever workup included urinalysis, urine culture, blood culture, and chest x-ray. Fever predictors were analyzed using a generalized linear mixed model.

Results: Cohort included 222 patients, aged 0.01-40.35 years (median 5.27, SD = 8.32). Ninety-four patients (42 %) developed early postoperative fever. Factors predictive of developing fever included intraoperative transfusion (p = 0.032), postoperative transfusion (p = 0.032), foley catheter (p < 0.001), neutropenia (p = 0.001), and sarcoma histology (p = 0.006). Of those who developed fever, 36 % (34/94) were treated with empiric antibiotics and 73.4 % (69/94) underwent febrile workup (average cost $455). Only 2.8 % (2/94) of febrile patients had an infectious etiology requiring treatment. Both had hemodynamic instability and positive blood cultures.

Conclusions: Postoperative fever is common in pediatric cancer patients. Infectious etiology is rare, empiric treatment is common, and workup is costly. Fever alone may not necessitate a workup within the first 2 postoperative days following solid tumor resection. Testing and treatment should be reserved for those with significant symptomatology.

The text in the image

Early Post-Op Fever in Pediatric Oncology Patients Undergoing Solid Tumor Resection | Single-center Retrospective Review | 2018-2023 | 222 patients After solid tumor resection | Median age = 5 yrs old | Reviewed fevers ≤ 72 hrs post-op | Common workup: Urine analysis, urine/blood cultures, chest X-Ray | 2.8 % had a true infection (unstable + positive cultures) | 42% had early post-op fever | 73 % received fever workups | 36 % treated empirically | Predictors: Transfusions, Foley catheter, neutropenia, sarcoma histology | Conclusion: Fever is common but rarely infectious. Routine workup within 72 h is low yield—reserve testing for symptomatic or unstable patients. | https://pubmed.ncbi.nlm.nih.gov/40907880/ | Lundstedt J et al. | Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, USA | Journal of Pediatric Surgery | @LizzyPAC8 @globalcastmd @StayCurrentMD | Cincinnati Children's

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